Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib
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WORLD JOURNAL OF SURGICAL ONCOLOGY
CASE REPORT
Open Access
Spontaneous splenic rupture in patient with metastatic melanoma treated with vemurafenib Elisa Castellani1, Piero Covarelli1, Carlo Boselli1, Roberto Cirocchi2, Antonio Rulli1, Francesco Barberini1, Daniela Caracappa1, Carla Cini1, Jacopo Desiderio2*, Gloria Burini1 and Giuseppe Noya1
Abstract Background: BRAF inhibitors such as vemurafenib are a new family of biological drugs, recently available to treat metastatic malignant melanoma. Methods: We present the case of a 38-year-old man affected by metastatic melanoma who had been under treatment with vemurafenib for a few days. The patient suffered from sudden onset of abdominal pain due to intra-abdominal hemorrhage with profuse hemoperitoneum. An emergency abdominal sonography confirmed the clinical suspicion of a splenic rupture. Results: The intraoperative finding was hemoperitoneum due to splenic two-step rupture and splenectomy was therefore performed. Histopathology confirmed splenic hematoma and capsule laceration, in the absence of metastasis. Conclusions: This report describes the occurrence of a previously unreported adverse event in a patient with stage IV melanoma receiving vemurafenib. Keywords: Spontaneous splenic rupture, Melanoma, BRAF, Vemurafenib
Background Atraumatic splenic rupture (ASR) is a rare pathology that can be idiopathic (7%) or pathological (93%) in nature [1]. While in the first group there are no abnormal histopathological findings, in the second one several etiological factors can be identified, including neoplastic (30%), infectious (27%), inflammatory non-infectious (20%), drug- or treatment-related (9%), and mechanical disorders (6%) [1]. ASR is an often unrecognized and potentially fatal cause of acute abdomen development; it should be routinely considered in the differential diagnosis of such pathology and when present promptly managed, at best with laparotomic approach [2]. The commonest causes of this rare pathology are: malignant hematological disorders (16%) such as acute leukemia and non-Hodgkin’s lymphoma; viral infections (15%) as infectious mononucleosis and cytomegalovirus infection; and local * Correspondence: [email protected] 2 Department of General Surgery, University of Perugia, St. Maria Hospital, Via Tristano di Joannuccio, Terni 05100, Italy Full list of author information is available at the end of the article
inflammatory and neoplastic disorders (11%) such as acute and chronic pancreatitis. Splenomegaly is a common feature, affecting 55% of patients. There is a male gender prevalence of 2:1, with a mean age of 45 years, (median 45, range 18–86 years). The overall ASR-related mortality rate is 12% [1]. Although, nowadays, the laparoscopic approach is the routine procedure for various diseases requiring elective splenectomy, in emergency cases laparotomy still retains its effectiveness, first and foremost with regard to patients with unstable hemodynamic conditions.
Case presentation In September 2011, a 38-year-old man was admitted in urgency
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