Antineoplastics
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Reactions 1444 - 23 Mar 2013 S Antineoplastics Acute liver failure due to reactivation of hepatitis B virus: case report A 42-year-old man developed acute liver failure due to reactivation of hepatitis B virus (HBV) following chemotherapy with cyclophosphamide, doxorubicin, prednisolone, rituximab, and vincristine for gastric lymphoma [routes and dosages not stated]. He subsequently died. The man was brought to hospital unconscious. He had been diagnosed with gastric lymphoma 6 months previously and had undergone chemotherapy. His chemotherapy regimen consisted of three cycles of cyclophosphamide, doxorubicin, prednisolone, and vincristine every 3 weeks. Rituximab was added to the regimen for his fourth cycle because of a low response to the previous cycles. One week later, he developed nausea and vomiting. Two days prior to admission, he developed fever, jaundice, icteric skin, and tea-coloured urine. He had a history of blood transfusion and alcohol consumption. Examination revealed tachycardia, tachypnoea, oedema, and hepatomegaly. He was also delirious. Laboratory tests 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 a high care unit. Tests were positive for HBsAg. Ultrasonography revealed non-specific hepatomegaly. The man’s treatment included ornithine aspartate, lamivudine, and adefovir. On day 3 of follow-up, he remained unconscious. His AST and ALT levels had decreased and his haematemesis had stopped but his bilirubin was elevated and his PT/aPTT was still prolonged. On day 5, his AST and ALT levels were 319 and 491, respectively. However, his bilirubin was highly elevated. He eventually died due to fulminant liver failure. Author comment: "Here we report a male patient with acute liver failure due to reactivation of hepatitis B related to chemotherapy." Wijaya I, et al. Acute liver failure related to chemotherapy. Acta Medica Indonesiana 44: 145-9, No. 2, Apr 2012 - Indonesia 803084719 1 Reactions 23 Mar 2013 No. 1444 0114-9954/10/1444-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Antineoplastics
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
