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Ototoxicity and fatal hepatitis B reactivation: case report A 44-year-old woman developed fatal hepatitis B reactivation following treatment with cisplatin and carboplatin in addition to concurrent radiation for cervical cancer. Additionally, she also developed ototoxicity during treatment with cisplatin. The woman with a history of chronic, untreated hepatitis B infection was diagnosed with stage IIIB cervical cancer. Treatment was recommended to her, but she did not return to the clinic for the start of therapy. Six months later she developed new lesions and worsening bilateral hydrosalpinx. Therefore, she started receiving cisplatin 40 mg/m2 weekly [route not stated] with concurrent radiation. Prior to start of the therapy her HBV-DNA level was 661 UI/mL. She was scheduled to initiate entecavir 0.5mg daily; however, she never started the medication. She completed 3 doses of cisplatin with concurrent radiation. She developed cisplatinrelated ototoxicity The woman’s treatment was switched to carboplatin [dosage and route not stated]. Subsequently, she developed various cytopenias [aetiology not stated] and carboplatin was stopped. Then she started interstitial brachytherapy. While on treatment, she was also diagnosed with acute deep vein thrombosis and pulmonary embolism. She was treated with enoxaparin-sodium [enoxaparin]. Later, her treatment was switched from interstitial brachytherapy to intracavitary brachytherapy to minimise the bleeding risk. She continued the intracavitary brachytherapy and also received one dose of carboplatin (AUC-2). Subsequently, her AST and ALT levels were mildly elevated. Her HBV-DNA viral load was elevated in the subsequent days. Later, she was admitted with acute liver failure and lab examinations were as follows: AST 1179 U/l, ALT 2684 U/l, total bilirubin 12.5 mg/dL and serum HBV-DNA level >100,000,000 UI/mL. HBV reactivation was confirmed. Her Naranjo adverse drug reaction probability score was 6, indicating a probable adverse reaction. Therefore, she was diagnosed with cisplatin and carboplatin induced HBV reactivation. She started receiving oral entecavir 1mg once a day. But, her clinical condition deteriorated rapidly. Her liver function tests were stabilised. However, she became increasingly encephalopathic. She also started receiving lactulose and rifaximin [routes and dosages not stated]. However, she had no improvement despite the treatment. Her clinical status worsened with hypovolemic shock and effective arterial blood volume was decreased. She had continued worsening of mental status and encephalopathy. She also developed coagulopathy, hypoglycaemia, and metabolic acidosis. She was then intubated. She was also unresponsive to unspecified vasopressors. Then she developed ventricular tachycardia followed by asystole. Later she died. Dimond C, et al. Fatal hepatitis B reactivation in a patient receiving chemoradiation for cervical cancer. Journal of Oncology Pharmacy Practice : no pagination, Jan 2020. 803514292 Available from: URL: http://doi.org/10.1177/10781552209