Subacute liver failure caused by immunotherapy in a patient with gastric cancer was improved after multimodal treatment with artificial liver combined with liver-protective drugs: a case report

The emergence of the anti-tumor immunotherapy era has led to the widespread adoption of immune checkpoint inhibitors (ICIs) in clinical practice. While ICIs exhibit substantial anti-tumor efficacy across a broad range of malignancies, they may also induce a diverse spectrum of immune-related adverse events (irAEs), involving multiple organ systems and, in severe instances, resulting in life-threatening complications. This report describes a rare case of severe immune-mediated hepatotoxicity (IMH) in a 76-year-old male patient with postoperative gastric cancer who was undergoing adjuvant therapy with camrelizumab in combination with oxaliplatin and S-1 (SOX regimen). The condition presented as CTCAE v5.0 Grade 4 IMH and subsequently progressed to subacute liver failure (SALF). Following an inadequate response to conventional hepatoprotective agents, glucocorticoids, and immunosuppressants, the patient received artificial liver support therapy consisting of two sessions of plasma exchange (PE) and three sessions of a double plasma molecular adsorption system (DPMAS), administered in an alternating sequence. After this multimodal intervention, liver function demonstrated marked recovery and returned to normal levels four months after discharge. No tumor recurrence occurred during follow-up, and hepatic function remained stable through August 2025. This case highlights the critical need for early recognition and prompt, comprehensive management of severe ICI-related liver injury and supports the potential clinical utility of artificial liver support systems in such scenarios.