Table 5

Cirrhosis-related disorders that should be considered in the diagnostic workup of irAEs in patients with HCC (Adapted from Sangro et al, J Hepatol 2020)179

OrganirAEChronic liver disease
Skin
  • Pruritus

  • Rash

  • Erythema multiforme, psoriasis, urticaria and rosácea

  • Severe cutaneous adverse reactions

  • Pruritus

  • Skin disorders, including lichen planus, polyarteritis nodosa, cryoglobulinemic vasculitis, and porphyria cutanea tarda (HCV- and HBV-related)

GI tract
  • Diarrhea

  • Colitis

  • Small intestine bacterial overgrowth

  • Chronic pancreatitis

Liver
  • Hepatitis

  • Flares or viral infection

Lung
  • Pneumonitis

  • Hepatopulmonary syndrome

  • Porto-pulmonary hypertension

Thyroid
  • Hypothyroidism

  • Hyperthyroidism

  • Graves’ disease

  • Reduced peripheral conversion of T4 to T3

  • Thyroid dysfunction

Adrenal glands and pituitary glands
  • Adrenal insufficiency

  • Hypophysitis

  • Hypogonadism

  • Hypothalamic-pituitary dysfunction

  • Relative adrenal insufficiency

Kidney
  • Nephritis

  • Hepatorenal syndrome

  • Mixed cryoglobulinemia (HCV-related)

  • HBV-related nephropathy

  • IgA nephropathy

Nervous system
  • Encephalitis

  • Aseptic meningitis

  • Peripheral neuropathy

  • Myasthenia gravis

  • Guillain-Barre syndrome

  • Autonomic neuropathy

  • Transverse myelitis

  • Porto-systemic encephalopathy (typical and atypical)

  • Viral-related peripheral neuropathy

  • Wernicke’s encephalopathy

  • Autonomic neuropathy (HCV-related)

Blood and bone marrow
  • Cytopenias

  • Hemolytic anemia

  • Red cell aplasia

  • Bone marrow failure

  • Hemophilia A

  • Hemophagocytic lymphohistiocytosis

  • Macrophage activation syndrome

  • Hypersplenism and bone marrow depression

  • Anemia due to folate or iron deficiency

  • Hemolytic anemia

  • Viral-related thrombotic thrombocytopenic purpura and aplastic anemia

  • Immune thrombocytopenia (HCV-related)

  • Lymphopenia related to HCC therapies

  • GI, gastrointestinal; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; irAE, immune-related adverse event.