Lenvatinib
- PDF / 170,526 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 37 Downloads / 156 Views
1 S
Acute acalculous cholecystitis: case report A 67-year-old man developed acute acalculous cholecystitis during treatment with lenvatinib for hepatocellular carcinoma (HCC). The man, who had advanced HCC secondary to chronic hepatitis, started receiving lenvatinib 12 mg/day [route not stated]. However, on day 6, he developed a fever, accompanied by right upper quadrant pain. He was hospitalised. Blood tests revealed increased inflammatory markers, including CRP, WBC count with a neutrophil left shift and liver enzymes. Contrast-enhanced CT (CE-CT) scan revealed a swollen gallbladder with wall thickening. Contrast effect of the gallbladder wall was heterogenous but maintained. Ultrasound and CE-CT scans revealed no obvious gallbladder stones; however, high density sedimentation was noted in the gallbladder, suggesting necrotic cell debris or bleeding from the gallbladder wall. Hence, drug-induced acute acalculous cholecystitis was suspected. Lenvatinib was discontinued, and the man was treated with piperacillin/tazobactam. Endoscopic retrograde cholangiopancreatography was performed. A nasogallbladder drainage catheter was placed. The aspirated bile contained blood components. Cultures for aerobic and anaerobic bacteria were found negative. Intraductal ultrasonography and cholangiography revealed no evidence of stones and debris in common bile ducts (CBD). Since there was no evidence on cancerous lesions or stones in the CBD, the elevated hepatobiliary enzymes were thought to be associated with lenvatinib. Follow-up transabdominal ultrasound performed 8 days after gallbladder drainage revealed marked improvement in the gallbladder swelling and wall thickening; hence, the catheter was withdrawn. Five days after removal of the catheter, lenvatinib was resumed at a reduced dose of 4 mg/day. However, 7 days later, the man had a recurrence of acute acalculous cholecystitis. CT scan revealed no inflammatory changes in the other biliary tract, including the extrahepatic and intrahepatic bile ducts. Blood tests revealed elevated inflammatory markers, including CRP, WBC count with a neutrophil left shift and liver enzymes. The recurrent acute cholecystitis was managed with discontinuation of lenvatinib and fasting, and it improved with conservative management. Lenvatinib was not resumed. Thereafter, the acute acalculous cholecystitis did not recur. He later received hepatic arterial infusion chemotherapy for multiple HCC. Ishigaki K, et al. Lenvatinib-induced acute acalculous cholecystitis in a patient with hepatocellular carcinoma. Clinical Journal of Gastroenterology 13: 568-571, No. 4, 2020. 803507191 Available from: URL: http://doi.org/10.1007/s12328-020-01116-5
0114-9954/20/1826-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 17 Oct 2020 No. 1826
Data Loading...
