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Case Report Open Access

Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists

  • Authors:
    • Xiao Zeng
    • Tiantian Liu
    • Guilan Jin
  • View Affiliations / Copyright

    Affiliations: Department of Pharmacy, The First College of Clinical Medicine Science, China Three Gorges University, Yichang, Hubei 443000, P.R. China, Department of Oncology, Yichang Central People's Hospital, Yichang, Hubei 443000, P.R. China
    Copyright: © Zeng et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 123
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    Published online on: September 1, 2026
       https://doi.org/10.3892/br.2026.2196
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Abstract

The present study reported the case of a 48‑year‑old female who developed drug‑induced autoimmune‑like hepatitis (DI‑ALH) during adjuvant oxaliplatin, 5‑fluorouracil and leucovorin calcium (FOLFOX) therapy for rectal cancer. The initial liver injury was attributed to non‑specific chemotherapy‑associated hepatotoxicity, resulting in a delay in the correct diagnosis. Recurrent transaminitis following oxaliplatin rechallenge subsequently suggested an immune‑mediated mechanism. A clinical pharmacist played a central role in the multidisciplinary team by leading the causality assessment and developing an individualized corticosteroid management strategy, which enabled completion of all 12 planned cycles of FOLFOX without severe hepatic flares. Liver enzyme levels normalized following completion of chemotherapy and remained stable after glucocorticoid discontinuation during 12 months of follow‑up. The present case report highlighted that DI‑ALH may closely resemble idiopathic autoimmune hepatitis but typically resolves after withdrawal without the need for long‑term immunosuppressive therapy. It also underscored the important contribution of clinical pharmacists in the recognition, assessment and management of complex chemotherapy‑associated toxicities.
View Figures

Figure 1

Serial imaging showed no local pelvic
recurrence or distant metastases throughout treatment. The five
rows represent key time-points: Pre-op staging (August 2024),
Post-op and Pre-chemo (September 2024), post- RT (November 2024),
Post-C2 (January 2025) and end of chemo (June 2025). The three
columns display representative axial slices of the pelvis, upper
and lower abdomen and thorax. Pelvic imaging: CE-CT was used at the
first two visits (August 2024, September 2024), with T2-weighted
MRI adopted for subsequent follow-ups due to superior soft-tissue
contrast for detecting subtle recurrence and small lymph nodes.
Abdominal and thoracic scans: Only CE-CT phases are shown, as they
provide sufficient diagnostic information. For pelvic MRI, only
T2-weighted images are presented to better distinguish
postoperative scarring from potential recurrence. A coloured arrow
marks the primary rectal lesion on the preoperative pelvic CT; no
markers are added elsewhere, as no recurrence or metastases were
identified at any time-point. CE-CT, contrast-enhanced computed
tomography; MRI, magnetic resonance imaging; Pre-op, pre-operative;
Post-op, post-operative; Pre-chemo, before chemotherapy; RT,
radiotherapy; Post-C2, after 2 cycles of chemotherapy; end of
chemo, upon chemotherapy completion.

Figure 2

Trends in transaminase levels during
chemotherapy and glucocorticoid treatment from September 2024 to
May 2025. The timeline extends from initiation of FOLFOX
chemotherapy in September 2024, to completion of all 12 treatment
cycles in May 2025, and illustrates temporal changes in liver
enzyme levels. The x-axis represents the date. The left y-axis
indicates serum transaminase concentrations, whereas the right
y-axis shows the fold increase above the ULN. Blue bars represent
transaminase levels, with palest blue indicating GGT, light blue
indicating AST and dark blue indicating ALT. Yellow line graphs
represent the fold increase above the ULN over time, with light
yellow indicating AST and orange indicating ALT; fold-ULN values
were not calculated for GGT, and therefore no corresponding line is
presented for this parameter. A total of 12 grey arrows indicate
the timing of the 12 FOLFOX chemotherapy cycles. The purple shaded
area denotes the period of concurrent chemoradiotherapy (pelvic RT
plus capecitabine). Green shaded areas indicate administration of
prophylactic IV methylprednisolone (40 mg once daily) for three
consecutive days after the start of each FOLFOX cycle, followed by
maintenance oral prednisone (10 mg once daily) until the subsequent
treatment cycle. A marked increase in transaminase levels was
observed following the second FOLFOX cycle, followed by a rapid
decline after initiation of glucocorticoid therapy (black arrow).
ALT, alanine aminotransferase; AST, aspartate aminotransferase;
FOLFOX, oxaliplatin, 5-fluorouracil, leucovorin; GGT,
gamma-glutamyl transferase; ULN, upper limit of normal; RT,
radiotherapy; MP, methylprednisolone; Pred, prednisone; IV,
intravenous; PO, per os (oral); d, days.

Figure 3

Serial surveillance imaging during
post-chemotherapy follow-up. A total of four sequential quarterly
imaging assessments were performed in September 2025, December
2025, March 2026 and June 2026. Each time-point comprises pelvic
CE-MRI (first column), abdominal CE-CT (second column) and thoracic
CE-CT (third column). Abdominal and thoracic scans: Only CT phases
are shown, as they provide sufficient diagnostic information. For
pelvic MRI, only T2-weighted images are presented to better
distinguish postoperative scarring from potential recurrence. A
yellow arrow indicates a 3x3 mm right middle lobe lateral segment
micronodule on the March 2026 thoracic CE-CT for surveillance. The
lesion resolved at the same location later that same month,
possibly caused by infection. All serial scans demonstrate stable
rectal adenocarcinoma without evidence of local progression,
regional recurrence or distant metastasis. CE-MRI,
contrast-enhanced magnetic resonance imaging; CE-CT,
contrast-enhanced computed tomography.

Figure 4

Diagnostic pathway for
oxaliplatin-induced ALH. The flowchart summarizes the clinical
assessment process leading to the diagnosis of oxaliplatin-induced
ALH, including evaluation of liver enzyme abnormalities, exclusion
of alternative causes, causality assessment and differentiation
from idiopathic autoimmune hepatitis. ALH, autoimmune-like
hepatitis; ALT, alanine aminotransferase; AST, aspartate
aminotransferase; DILI, drug-induced liver injury; FOLFOX,
oxaliplatin, 5-fluorouracil, leucovorin calcium; AIH, autoimmune
hepatitis.
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Spandidos Publications style
Zeng X, Liu T and Jin G: Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists. Biomed Rep 25: 123, 2026.
APA
Zeng, X., Liu, T., & Jin, G. (2026). Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists. Biomedical Reports, 25, 123. https://doi.org/10.3892/br.2026.2196
MLA
Zeng, X., Liu, T., Jin, G."Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists". Biomedical Reports 25.5 (2026): 123.
Chicago
Zeng, X., Liu, T., Jin, G."Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists". Biomedical Reports 25, no. 5 (2026): 123. https://doi.org/10.3892/br.2026.2196
Copy and paste a formatted citation
x
Spandidos Publications style
Zeng X, Liu T and Jin G: Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists. Biomed Rep 25: 123, 2026.
APA
Zeng, X., Liu, T., & Jin, G. (2026). Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists. Biomedical Reports, 25, 123. https://doi.org/10.3892/br.2026.2196
MLA
Zeng, X., Liu, T., Jin, G."Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists". Biomedical Reports 25.5 (2026): 123.
Chicago
Zeng, X., Liu, T., Jin, G."Oxaliplatin‑induced autoimmune‑like hepatitis: A case report highlighting the role of clinical pharmacists". Biomedical Reports 25, no. 5 (2026): 123. https://doi.org/10.3892/br.2026.2196
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