An elderly female melanoma patient who experienced severe liver injury after treatment with pembrolizumab and axitinib, which improved with glucocorticoid therapy. Through medication analysis and adverse reaction scale evaluated, it was considered that severe liver injury was more closely related to the immune checkpoint inhibitor, pembrolizumab. After a comprehensive analysis of the relationship between liver injury and immunotherapy, as well as the benefits and risks of immunotherapy for patients, immunotherapy was rechallenged 40 days after discontinuation of pembrolizumab. Restarting treatment with pembrolizumab after immune-mediated hepatitis poses a risk of recurrence of hepatotoxicity. After reviewing related literature, it had been found that the incidence of severe hepatotoxicity caused by rechallenging treatment was low, and the overall safety was controllable. Pembrolizumab had brought therapeutic benefits to patients, with no further immune-mediated liver injury of 5 cycles medication. This case can provide a reference for rechallenging immunotherapy after immune-mediated hepatitis.

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