A Case of Pernicious Anemia Induced by Atezolizumab in Hepatocellular Carcinoma and Renal Cell Carcinoma

10 May 2026 : Case report Japan

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Adverse events of drug therapy

Takeshi Sugimoto^{ABCDEF 1*}, Gen Kanemori^{B 1}, Hirohumi Kanehira^{C 2}, Akihito Kitao^{D 2}, Yoshiaki Nagatani^{E 3}

DOI: 10.12659/AJCR.952800

Am J Case Rep 2026; 27:e952800

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Table 1 Laboratory data on admission.

White blood cell	23	×10/μL	Total bilirubin	1.28	mg/dL	Parietal cell antibodies	×20	Titer
Neutrophil	61.3	%	Direct bilirubin	0.13	mg/dL	Intrinsic factor antibodies	(−)
Monocyte	5.7	%	BUN	14.3	mg/dL	Anti-nuclear antibodies	×40	Titer
Lymphocyte	32.6	%	Creatinine	0.78	mg/dL	Platelet-associated IgG	121	ng/10 cells
Eosinophil	0.4	%	Na	140	mEq/L	Direct anti-globulin test	(−)
Basophil	0	%	K	4.4	mEq/L	Indirect anti-globulin test	(−)
Red blood cell	152	×10/μL	Cl	107	mEq/L	High-sensitivity PNH cells	(−)
Hemoglobin	6.1	g/dL	CRP	0.64	mg/dL	Free T4	1.09	ng/dL
MCV	116	fL	Vitamin B12	<148	pg/mL	TSH	2.57	mIU/L
MCH	40.1	pg	Folic acid (4–999)	12.2	ng/mL	ACTH (7.2–63.3)	66.9	pg/ml
MCHC	34.7	%	Gastrin (11.9–46.9)	300	pg/mL	Cortisol (3.7–19.4)	13.3	μg/dL
Platelet	5.8	×10/μL	Haptoglobin	<10	mg/dL	AFP (0–10)	<2	ng/mL
Reticulocyte	3.8	×10/μL	Vitamin B1 (24–66)	18	ng/mL	PIVKAII (0–39)	32	mAU/mL
AST	17	IU/L	Cu (68–128)	89	μg/dL	antibodies (<10)	<3	U/ml
ALT	10	IU/L	Zn (80–130)	70	μg/dL
LD	369	IU/L	IgG	966	mg/dL
LD1	42	%	IgA	152	mg/dL
LD2	34	%	IgM	42	mg/dL
LD3	14	%	C3	96	mg/dL
LD4	5	%	C4	23	mg/dL
LD5	5	%	CH50	48	U/mL

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