Liver injury from anti-PD-1 seems to be nonspecific, consisting of a lymphocytic (most often panlobular) pattern of hepatocellular injury along with portal inflammation.[17,18] Features of anti-CTLA-4 hepatitis are different and include lobular hepatitis with poorly defined granulomas and fibrin ring granulomas, sinusoidal histiocytic infiltrates, and central vein endothelitis.[17,19–21] On the other hand, histologic hallmarks of AIH like extensive plasma cell infiltration, hepatocellular rosettes and emperipolesis appear to be absent in ICPI-related hepatitis. The gene discussed is CTLA4; the disease is Granuloma.