Recurrent Immune Checkpoint Inhibitor Hepatitis With Pembrolizumab Cessation: A Stubborn Case of Delayed-Onset, Steroid-Refractory Hepatotoxicity

Abstract Immune checkpoint inhibitors such as pembrolizumab are increasingly used in cancer therapy, yet immune-related adverse events like immune-mediated liver injury from checkpoint inhibitors remain challenging to diagnose and manage. Most cases arise early in treatment and respond to corticosteroids, but rare delayed or refractory presentations have been described. We report a unique case of delayed-onset, steroid-refractory immune-mediated liver injury from checkpoint inhibitors requiring escalation of therapy despite prolonged discontinuation of the causative agent, highlighting the need for continued vigilance and individualized management strategies in patients receiving immune checkpoint inhibitors.