Reactions 1444 - 23 Mar 2013

SAntineoplastics

Acute liver failure due to reactivation of hepatitis Bvirus: case report

A 42-year-old man developed acute liver failure due toreactivation of hepatitis B virus (HBV) following chemotherapywith cyclophosphamide, doxorubicin, prednisolone,rituximab, and vincristine for gastric lymphoma [routes anddosages not stated]. He subsequently died.

The man was brought to hospital unconscious. He had beendiagnosed with gastric lymphoma 6 months previously andhad undergone chemotherapy. His chemotherapy regimenconsisted of three cycles of cyclophosphamide, doxorubicin,prednisolone, and vincristine every 3 weeks. Rituximab wasadded to the regimen for his fourth cycle because of a lowresponse to the previous cycles. One week later, he developednausea and vomiting. Two days prior to admission, hedeveloped fever, jaundice, icteric skin, and tea-coloured urine.He had a history of blood transfusion and alcoholconsumption. Examination revealed tachycardia, tachypnoea,oedema, and hepatomegaly. He was also delirious. Laboratorytests revealed the following: AST 1295, ALT 1051, LDH 1137[units not stated], hyperbilirubinaemia, hypoalbuminaemia,and prolonged PT/aPTT. A nasogastric tube was inserted,revealing 400cc of dark-coloured fluid. He was admitted to ahigh care unit. Tests were positive for HBsAg. Ultrasonographyrevealed non-specific hepatomegaly.

The man’s treatment included ornithine aspartate,lamivudine, and adefovir. On day 3 of follow-up, he remainedunconscious. His AST and ALT levels had decreased and hishaematemesis had stopped but his bilirubin was elevated andhis PT/aPTT was still prolonged. On day 5, his AST and ALTlevels were 319 and 491, respectively. However, his bilirubinwas highly elevated. He eventually died due to fulminant liverfailure.

Author comment: "Here we report a male patient withacute liver failure due to reactivation of hepatitis B related tochemotherapy."Wijaya I, et al. Acute liver failure related to chemotherapy. Acta MedicaIndonesiana 44: 145-9, No. 2, Apr 2012 - Indonesia 803084719

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Reactions 23 Mar 2013 No. 14440114-9954/10/1444-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved