Sequential fulminant hepatitis and toxic epidermal necrolysis induced by tislelizumab: A case report

Immune checkpoint inhibitors (ICIs)-monoclonal antibodies that block inhibitory pathways such as programmed cell death protein 1 (PD-1)/PD-1 ligand to restore T-cell antitumor activity-are increasingly used in advanced non-small cell lung cancer. These agents are associated with severe multisystem immune-related adverse events (irAEs). The present study reported the first case of sequential grade 4 hepatotoxicity and toxic epidermal necrolysis (TEN) induced by the anti-PD-1 antibody tislelizumab. A 70-year-old female patient with advanced lung squamous cell carcinoma developed acute severe mixed liver injury (alanine aminotransferase, 1,741.6 U/l) followed by extensive TEN shortly after initiation of tislelizumab combined with chemotherapy. The toxicities were refractory to conventional hepatoprotective and antihistamine therapies but responded to high-dose corticosteroids combined with intravenous immunoglobulin (IVIG), leading to full recovery. This case highlights that PD-1 inhibitors can induce rare yet life-threatening overlapping irAEs. Clinicians should maintain heightened vigilance for such severe toxicities, particularly in elderly patients receiving combination immunotherapy, and promptly initiate multidisciplinary management including corticosteroids and IVIG.