Vemurafenib-induced granulomatous hepatitis.

Area of Science:

• Oncology
• Hepatology
• Pharmacology

Background:

• Vemurafenib is an oral chemotherapy targeting the BRAF V600E mutation in metastatic melanoma.
• Protein kinase inhibitors (PKIs) like vemurafenib can cause side effects, including dermatologic and constitutional symptoms.
• Hepatotoxicity is a known concern with vemurafenib, with reported mild and severe liver biochemistries abnormalities.

Observation:

• A case of severe vemurafenib-induced granulomatous hepatitis is presented.
• The patient developed chronic cholestasis secondary to the drug-induced liver injury.
• This adverse event occurred despite the known risks of vemurafenib on liver function.

Findings:

• Vemurafenib can lead to severe hepatic injury, specifically granulomatous hepatitis.
• The liver injury may progress to chronic cholestasis, a prolonged bile flow impairment.
• A review of other PKIs' hepatotoxicity is included for comparative analysis.

Implications:

• Clinicians should be vigilant for signs of severe liver injury in patients treated with vemurafenib.
• Monitoring liver function is crucial for early detection and management of vemurafenib-induced hepatotoxicity.
• Understanding the spectrum of PKI-related liver injury aids in patient management and risk assessment.