Distinguishing Between Acute Exacerbation of Chronic Hepatitis C Infection and Immune-Mediated Hepatitis in a Patient with Liver Injury Following Treatment with Tremelimumab Plus Durvalumab

Key Points

• This case examines differentiating between acute exacerbation of chronic hepatitis C and immune-mediated hepatitis following immunotherapy.
• A 60-year-old male patient with liver cancer and hepatitis C was treated with Tremelimumab and Durvalumab.
• He received catheter-directed arterial embolization due to the unresectable tumor and developed liver dysfunction.
• Steroids and immunosuppressants were administered but ineffective; subsequently, hepatitis treatment was initiated.
• Hepatic function normalized rapidly after initiating Glecaprevir and Pibrentasvir therapy.
• There was no recurrence of liver injury after resuming Durvalumab therapy.
• Emphasis was placed on the need to differentiate between immune-mediated liver injury and acute exacerbation of hepatitis C.