Case report: ICI-induced hepatitis and myositis with aspergillosis

We report the case of a 41-year-old woman with metastatic melanoma who developed grade 4 immune checkpoint in­hi­bi­tor (ICI)-induced hepatitis and autoimmune myositis fol­lo­wing combination therapy with nivolumab and ipi­li­mu­mab. Liver biopsy confirmed the diagnosis, and her he­pa­ti­tis proved refractory to high-dose corticosteroids, re­qui­r­ing escalation to mycophenolate mofetil (MMF) and sub­sequently tacrolimus. She also developed bilateral lo­wer extremity weakness consistent with immune-re­la­ted myositis, and she was diagnosed with pulmonary as­per­gil­lo­sis during hospitalization. This case highlights the importance of early recognition, tissue diagnosis, mul­ti­dis­ci­pli­na­ry coordination, and proactive infection monitoring in the management of high-grade immune-related adverse events (irAEs).