A case of Large-cell lung carcinoma successfully treated wit
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An 80-year-old Japanese woman was referred with a 1-month history of pain near the left shoulder. The patient’s medical history only include lumbar compression fracture. On physical examination, her dull pain near the left shoulder worsened on movement. Chest radiography and (CT) revealed a mass shadow measuring 50 mm in the upper lobe of the left lung. The mass was in contact with the third to fifth ribs and invaded the fourth rib. A 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET)/computed tomography (CT) showed the accumulation of FDG in this mass, subaortic lymph nodes, left pleural effusion and second lumbar vertebra.

Treatment with pembrolizumab was initiated as a first-line therapy. Contrast-enhanced whole-body CT performed after eight courses of pembrolizumab treatment showed marked shrinkage of the tumor and disappearance of left pleural effusion. However, patient developed acute liver injury after the 8 courses of pembrolizumab treatment and underwent magnetic resonance cholangiopancreatography (MRCP) and a liver biopsy. A pathological examination showed slightly enlarged portal vein areas, infiltration of chronic inflammatory cells. Based on these results, the patient was diagnosed with sclerosing cholangitis.

Treatment was started with 40 mg/day of prednisolone, and reduced to 30 mg/day 2 weeks later and further to 25 mg/day 5 days later. During the therapy, her liver injury temporarily improved to Grade 1 but worsened at 1 month after the introduction of corticosteroids, so the dose was increased to 30 mg/day with immunosuppressant (azathioprine, 50 mg/day). Her liver injury further worsened so additional steroid pulse therapy (1000 mg/day of methylprednisolone for 3 days) was initiated. Her liver injury improved, and a repeated liver biopsy confirmed the pathological improvement of cholangitis six months after the onset of this condition, which enabled gradual corticosteroid reduction and immunosuppressant discontinuation. In addition, her lung cancer has not relapsed in the one year since the discontinuation of pembrolizumab.

source: https://www.sciencedirect.com/science/article/pii/S2213007120304111?dgcid=rss_sd_all
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