Tislelizumab-induced immune-mediated hepatotoxicity combined with two episodes of hepatitis B virus reactivation: a case report

Immune-mediated hepatotoxicity (IMH) is a typical immune-related adverse event associated with the use of immune checkpoint inhibitors (ICIs), while hepatitis B virus reactivation (HBVr) is an infectious complication that may also occur during ICI therapy. However, these two conditions are usually independent and rarely co-occur in the same individual. Herein, we describe a patient with lung squamous cell carcinoma who developed HBVr and IMH simultaneously after receiving tislelizumab, and the co-existence of two episodes of HBVr brings challenges to the diagnosis and treatment of IMH. In the diagnosis of IMH, the co-existence of HBVr masked the underlying IMH, resulting in a delay in IMH treatment. In the treatment of IMH, the re-occurrence of HBVr led to a dilemma of continuing to use glucocorticoids (GCs) or stopping them. In such a clinical scenario, the multidisciplinary approach, close monitoring of liver function and HBV-DNA, and a carefully balanced treatment strategy combining GCs with intensified antiviral therapy are essential to realize the optimal management for IMH. In conclusion, medical staff should be alert to the coexistence of HBVr and IMH in patients receiving ICIs, so as to avoid missed diagnosis and treatment delay.