• Zhenping Wu, Lingling Lai, Ming Li, Lunli Zhang, and Wenfeng Zhang.
• Department of Infectious Diseases, the First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
• Medicine (Baltimore). 2017 Dec 1; 96 (51): e9431.

RationaleKeytruda (pembrolizumab) is an inhibitor of programmed cell death receptor-1 (PD-1), which was approved to treat advanced melanoma and nonsmall cell lung cancer patients who do not respond to other treatment. However, its efficacy and security in the treatment of advanced liver cancer is still under investigation.Patient ConcernsA 60-year-old man was diagnosed with pulmonary metastatic liver cancer who accepted pembrolizumab treatment after the failure of sorafenib. When injected pembrolizumab, in spite of pulmonary metastatic lesion shrink, the patient experienced severe liver dysfunction.DiagnosesBased on the features of the clinical signs and laboratory examination,the patient was diagnosed with pembrolizumab-induced immune-related hepatitis by excluding other etiologies and drug-induced side effects.InterventionsThe patient received glucocorticoid and artificial liver (plasma exchange) therapy after failed conservative liver protection treatment.OutcomesThe patient's liver dysfunction continuously progressed and he finally died of liver failure and its complications during his hospitalization.LessonsPembrolizumab showed efficacy in an advanced hepatocellular carcinoma patient with lung metastases. However, it can generate immune-related adverse events such as immune-related hepatitis which can be lethal.Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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