Reactions 1442 - 9 Mar 2013

SAntineoplastics

Interstitial lung disease, portal hypertension andgastro-oesophageal variceal haemorrhage: casereport

A 48-year-old man with metastatic lung adenocarcinomadeveloped interstitial lung disease, followed by portalhypertension and gastro-oesophageal variceal haemorrhage,after treatment with antineoplastics.

The man, who had liver and bone metastases, startedreceiving gefitinib 250 mg/day [route not stated]. One monthlater, he was admitted to an emergency department with feverand progressive dyspnoea on exertion for several days. CTrevealed regression of his primary tumour and livermetastasis; however, there were diffuse opacities in both lungfields.

Gefitinib was thought to be the most likely cause of theman’s interstitial lung disease, and was immediatelywithdrawn. He received methylprednisolone andprednisolone, and his respiratory condition graduallyimproved. Two months after starting steroid therapy, his livertumour had regrown. He started receiving second-linechemotherapy with carboplatin AUC 5, pemetrexed500 mg/m2 and bevacizumab 15 mg/kg [frequencies and routesnot stated]. Ten days after receiving his fourth course, he wasreadmitted to an emergency department with hypotension,black stool and anaemic conjunctiva. Tests revealednormocytic anaemia and mildly elevated blood urea nitrogenlevels. Endoscopy showed beaded and dilated oesophagealvarices, suggestive of portal hypertension, as well as a gastricvarix with bloody gastric contents. CT showed atrophicregression in both hepatic lobes and heterogeneousenhancement of liver parenchyma, indicative of imbalancedportal vein blood flow. After a blood transfusion and successfulendoscopic variceal ligation, he was discharged. Follow-upendoscopy revealed regression of varices and a smoothmucosal surface.

Author comment: "Chemotherapy in series brought abouta dramatic regression of his metastatic liver tumor but mighthave caused the patient’s gastroesophageal varix bysubacutely inducing the hemodynamics of portalhypertension."Honda T, et al. Gastroesphageal variceal hemorrhage induced by metastatic livertumor of lung cancer. Case Reports in Oncology 5: 644-650, No. 3, Sep-Dec 2012.Available from: URL: http://dx.doi.org/10.1159/000345956 - Japan 803084018

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Reactions 9 Mar 2013 No. 14420114-9954/10/1442-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved