Cytokine release syndrome complicated with sepsis induced by tislelizumab in a patient with advanced hepatocellular carcinoma: A case report

In this study, we report a 69-year-old female patient with stage IIIB hepatocellular carcinoma (HCC) who developed sepsis concomitant with cytokine release syndrome (CRS) following treatment with tislelizumab (an anti-PD-1 monoclonal antibody) and subsequently demonstrated self-healing. After receiving tislelizumab-based immunotherapy, the patient presented with severe clinical manifestations, including fever, hypotension, and multiple organ dysfunction syndrome (MODS); however, after multidisciplinary evaluation regarding the potential risks of immunosuppression, immunosuppressive agents such as tocilizumab or corticosteroids were not applied, and the patient still experienced a good recovery through routine anti-infective therapy and aggressive supportive care. This case highlights the diagnostic complexity in distinguishing CRS from sepsis during anti-tumor immunotherapy and demonstrates that immunomodulatory therapy may not be mandatory in all patients. Collectively, the favorable outcomes achieved without tocilizumab or corticosteroids suggest that selected patients can recover through meticulous clinical monitoring and targeted interventions alone, thus highlighting the clinical importance of selecting patients who can be spared from immunosuppressive therapy.