Oxaliplatin
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Hepatoportal sclerosis, portal hypertension, and variceal bleeding: case report A 45-year-old woman developed hepatoportal sclerosis, portal hypertension, and variceal bleeding during treatment with oxaliplatin for colorectal cancer. The woman presented with anaemia, uncontrolled haematemesis, and upper GI bleeding. She had received oxaliplatin [route and dosage not stated] as part of an 8-month FOLFOX chemotherapy regimen which ended 1 month prior to presentation. She had tolerated the chemotherapy well until sudden-onset haematemesis prior to admission. Upper GI endoscopy revealed four columns of grade 2 oesophageal varices and an actively bleeding varix. There were also three gastric varices. There was evidence of portal hypertensive gastropathy. An initial liver biopsy revealed mild lobular and predominantly lymphocytic inflammation with scattered hepatocytic necrosis/dropout. The woman was treated with octreotide, a transfusion of packed red blood cells, esomeprazole, folic acid, and polysaccharide iron complex. She also received a transjugular intrahepatic portosystemic shunt (TIPS). The shunt resulted in an overall reduction in the portosystemic gradient from 23mm Hg to 3mm Hg. A follow-up liver biopsy revealed hepatoportal sclerosis. Portal tracts were inconspicuous and small. After a follow-up period of 3.5 years, she remained well with no further incidents of GI bleeding or ascites and no symptoms related to portal hypertension. Author comment: "Oxaliplatin was the most likely causative agent for the obliterated portal veins and hepatoportal sclerosis in this case, which would explain portal hypertension in the absence of fibrosis." Lawal TO, et al. Oxaliplatin-induced hepatoportal sclerosis, portal hypertension, and variceal bleeding successfully treated with transjugular intrahepatic portosystemic shunt. Clinical Colorectal Cancer 11: 224-227, No. 3, Sep 2012. Available from: URL: http://dx.doi.org/10.1016/j.clcc.2012.02.002 803078624 USA
0114-9954/10/1424-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Reactions 20 Oct 2012 No. 1424
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