scholarly journals Fatal Acute Liver Failure as a Consequence of Regorafenib Treatment in a Metastatic Colon Cancer

2017 ◽  
Vol 10 (2) ◽  
pp. 790-794 ◽  
Author(s):  
Dominique Béchade ◽  
Marie Desjardin ◽  
Claire Castain ◽  
Pierre-Henri Bernard ◽  
Marianne Fonck
Keyword(s):  
Liver Failure ◽  
Colon Adenocarcinoma ◽  
Treatment Monitoring ◽  
Concomitant Treatment ◽  
Metastatic Colon Cancer ◽  
Multikinase Inhibitor ◽  
Hepatic Involvement ◽  
Fatal Liver Failure ◽  
Hepatocyte Necrosis ◽  
Colorectal Cancer Patients

Regorafenib is a multikinase inhibitor which showed benefits in pretreated metastatic colorectal cancer patients. Hepatotoxicity has been described as a frequent side effect. We report the case of a 65-year-old patient presenting with jaundice, fever, and hepatocellular insufficiency which led to death of the patient. She had previously been treated with several lines of chemotherapy for sub- and diaphragmatic ganglionic metastases of a colon adenocarcinoma. There were no liver metastases. The fatal liver failure occurred at the beginning of treatment with regorafenib at a dosage of 3 tablets per day. No concomitant treatment was given, and other causes of liver damage were eliminated. The liver biopsy showed hepatocyte necrosis with lymphocyte infiltration. This observation illustrates the risk of severe hepatic involvement typically occurring within the first 2 months of treatment. Monitoring liver biology every 2 weeks is essential during the first 2 months to detect any hepatotoxicity.

Acute Liver Failure with Concurrent Bupropion and Carbimazole Therapy

2003 ◽  
Vol 37 (2) ◽  
pp. 220-223 ◽  
Author(s):  
Khoo Ai-Leng ◽  
Tham Lai-San ◽  
Lee Kang-Hoe ◽  
Lim Gek-Kee
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Concomitant Treatment ◽  
Probability Scale ◽  
Drug Induced ◽  
The Past ◽  
First Case ◽  
Concurrent Use ◽  
History Of ◽  
Fatal Liver Failure

OBJECTIVE: To report a case of fatal liver failure possibly associated with concurrent use of bupropion and carbimazole. CASE SUMMARY: A 41-year-old Chinese man with a history of hyperthyroidism had been treated with carbimazole and propranolol for the past 5 years. He received a 10-day course of bupropion as an aid for smoking cessation 10 weeks prior to presentation. He developed acute liver failure with rapid deterioration of renal function. Liver biopsy showed evidence of nonspecific drug-induced acute liver injury. His condition was further complicated by sepsis and coagulopathy. Death resulted 19 days after the onset of symptoms. The likelihood that bupropion induced hepatotoxicity in our patient was possible, based on the Naranjo probability scale. DISCUSSION: Although there is increasing evidence of hepatotoxicity induced by bupropion, this is the first case of fatality that could have resulted from acute liver failure in a patient receiving bupropion while on concomitant treatment with carbimazole. CONCLUSIONS: Clinicians should be aware of the possibility of acute liver insult induced by bupropion given concurrently with other hepatotoxic drugs.

scholarly journals N-Acetylcysteine (NAC) for the Prevention of Liver Failure in Heat Injury-Mediated Ischemic Hepatitis

2019 ◽  
Vol 184 (9-10) ◽  
pp. 565-567 ◽  
Author(s):  
Joshua S Will ◽  
Christopher J Snyder ◽  
Katie L Westerfield
Keyword(s):  
Liver Failure ◽  
Heat Stroke ◽  
Altered Mental Status ◽  
Hemodynamic Instability ◽  
Laboratory Evaluation ◽  
Heat Injury ◽  
Us Army ◽  
Ischemic Hepatitis ◽  
Intravenous Hydration ◽  
Hepatocyte Necrosis

Abstract Exertional Heat Illness with associated ischemic hepatitis (IH) is a common occurrence among military trainees; however, few specific therapies exist if unresponsive to appropriate supportive measures. A 27-year-old basic combat trainee presented with altered mental status, renal insufficiency, rhabdomyolysis, and a core temp of 107.9 °F after collapsing during a run, leading to the diagnosis of heat stroke. While the patient’s azotemia and creatinine kinase levels rapidly improved with aggressive intravenous hydration, transaminases continued to increase to nearly 155 times the upper limit of normal. Further laboratory evaluation revealed coagulopathy and thrombocytopenia suggestive of acute liver failure (ALF). On hospital day three, the patient was started on N-acetylcysteine (NAC). Evaluation for infectious and autoimmune etiologies of ALF was unremarkable; thus, the patient’s symptomatology was attributed to IH resulting from heat stroke. Liver function normalized on NAC. Heat Injury is common among US Army recruits and results in thousands of hospitalizations in recent years. IH is characterized by diffuse hepatocyte necrosis following an episode of hemodynamic instability, and is an established sequela of Heat Injury. The mortality of IH among critically ill patients has been estimated to be as high as 60%, with those demonstrating coagulopathy especially at risk. NAC is shown to improve the transplant-free survival rate in non-acetaminophen related ALF, consistent with its proposed mechanisms of improving hepatic blood flow and conjugating toxic metabolites. NAC therapy should be considered early in the course of heat injury-mediated IH to reduce reperfusion injury, improving transplant free outcomes.

Fatal Liver Failure in a Patient on Acetaminophen Treated with Sunitinib Malate and Levothyroxine

2009 ◽  
Vol 43 (4) ◽  
pp. 761-766 ◽  
Author(s):  
Amy M Weise ◽  
Chin Y Liu ◽  
Anthony F Shields
Keyword(s):  
Liver Failure ◽  
Assessment Method ◽  
Hepatic Necrosis ◽  
Potential Interaction ◽  
Neoplastic Disease ◽  
Sunitinib Malate ◽  
Sunitinib Treatment ◽  
Case Summary ◽  
Disease Stabilization ◽  
Fatal Liver Failure

Objective: To report the occurrence of fatal acute liver failure following addition of levothyroxine to a regimen of sunitinib and acetaminophen. Case Summary: A 57-year-old woman who started sunitinib treatment for relapsed metastatic gastrointestinal stromal tumor after imatinib failure had disease stabilization and normal livar function through 8 cycles of sunitinib 50 mg/day for 4 weeks, followed by 2 weeks off treatment. Her continuing medications included acetaminophen approximately 4.5 g/wk, as well as standard medications for asthma. In cycle 8, she received oral levothyroxine 50–150 pg/day for approximately 30 days to control hypothyroidism before beginning cycle 9 of sunitinib. On day 4 of cycle 9, she was hospitalized with progressively rising circulating liver enzyme levels. She died 4 days postadmission despite discontinuation of sunitinib and initiation of Intensive supportive treatment. At autopsy, her liver showed severe centrliobular necrosis with moderate-to-severe steatosis and minimal parenchymal invasion by the neoplasm. Viral stains were negative. Discussion: Hepatic failure has been reported rarely in patients receiving sunitinib. Autopsy results excluded neoplastic disease progression and viral infection in the etiology of the event, and the patient may have died of the combined interaction of sunitinib, acetaminophen, and levothyroxine. Although sunitinib was not more than a possible hepatotoxin (Roussel Uclaf Causality Assessment Method) and may even have been hepatoprotective over a 48-week period against chronic intake of acetaminophen (probable hepatotoxin) by producing regional hypothyroidism within the liver, it is hypothesized that correction of the putative hepatic hypothyroidism with oral levothyroxine (possible hepatotoxin) and reinitiation of sunitinib treatment may have triggered hepatic necrosis. Conclusions: Acetaminophen should be used with particular caution in patients receiving sunitinib. In sunitinib-treated patients who also require levothyroxine therapy, increased caution in restarting subsequent sunitinib treatment and discontinuation of acetaminophen, if possible, is advisable. Further evaluation of this potential interaction is warranted.

scholarly journals Colorectal Cancer that Highly Express Both ACE2 and TMPRSS2, Suggesting Severe Symptoms to SARS-CoV-2 Infection

2021 ◽  
Vol 27 ◽  
Author(s):  
Huai Wang ◽  
Jiankang Yang
Keyword(s):  
Colorectal Cancer ◽  
Dna Methylation ◽  
Viral Entry ◽  
Colon Adenocarcinoma ◽  
The Novel ◽  
Aberrant Expression ◽  
Systematic Analysis ◽  
More Care ◽  
Novel Coronavirus ◽  
Colorectal Cancer Patients

The epidemic of the novel, pathogenic SARS-coronavirus 2 (SARS-CoV-2) in the world pose a global health emergency. Cancer has been identified as a risk factor for the novel Coronavirus disease 2019 (COVID-19). The ACE2 and TMPRSS2 have been implicated in SARS-CoV-2 infection for mediating viral entry into the host cell. However, a systematic analysis of aberrant expression of ACE2 and TMPRSS2 was not yet reported in multiple human cancers. Here, we analyzed gene expression of ACE2 and TMPRSS2 across 31 types of tumors. Notably, overexpression of ACE2 and TMPRSS2 have been observed in colorectal cancer including colon adenocarcinoma (COAD), and rectum adenocarcinoma (READ). In addition, the colorectal tumors with upregulated gene expressing presented with decreased DNA methylation levels. DNA methylation might be one of the reasons for abnormal expression of ACE2 and TMPRSS2. Conclusively, colorectal cancer was the only cancer with the upregulated expression of ACE2 and TMPRSS2. More care of colorectal cancer patients is needed in multiple cancers affected by the COVID-19 outbreak.

scholarly journals Risk factors in the recurrence of the colorectal cancer

2002 ◽  
Vol 49 (2) ◽  
pp. 40-43 ◽  
Author(s):  
J. Ulanska ◽  
A. Dziki ◽  
W. Langner
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Rectal Cancer ◽  
Local Recurrence ◽  
Early Stage ◽  
Concomitant Treatment ◽  
Preventive Chemotherapy ◽  
Tnm System ◽  
Definition Of ◽  
Colorectal Cancer Patients

Traditionally, the clinical outcome of colorectal cancer patients may be predicted by pathological staging by either Dukes staging or the UICC-TNM system. However, some of Dukes stage A (approximately 10% of patients) and Dukes B patients (30-40%) will develop local recurrence or distant metastasis years after receiving standard surgical treatments. Therefore it is important to find some other indicators that can predict for recurrence so that we can screen for high-risk early-stage patients who may need preventive chemotherapy or other adjuvant therapy. The aim of this study is determination of risk factor for local recurrence in rectal cancer. In this study there has been used and summarized also research records and publications from different clinical hospitals according to actual international literature. Part of elements connected with patient, tumor and genetic and immunological factors remains independent on curative procedures. However better investigation these factors might affect on therapy, frequency of follow-up examinations, and help to detect recurrence at very early phase. Concomitant treatment factors are able to be moderate by surgeons and therapeutics. Therefore precise definition of risk factors might be helpful in decrease recurrence rate in patients with rectal cancer.

scholarly journals Non-Fatal and Fatal Liver Failure Associated with Valproic Acid

2012 ◽  
Vol 46 (02) ◽  
pp. 63-68 ◽  
Author(s):  
M. Schmid ◽  
R. Freudenmann ◽  
F. Keller ◽  
B. Connemann ◽  
C. Hiemke ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Liver Failure ◽  
Fatal Liver ◽  
Fatal Liver Failure

scholarly journals Synchronous recurrence of concurrent colon adenocarcinoma and dedifferentiated liposarcoma

2019 ◽  
Vol 12 (5) ◽  
pp. e228868
Author(s):  
Eric E Jung ◽  
F Scott Heinemann ◽  
Colt A Egelston ◽  
Jennifer Wang ◽  
Raphael E Pollock ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Immune Surveillance ◽  
Colon Adenocarcinoma ◽  
Complete Response ◽  
Dedifferentiated Liposarcoma ◽  
Metastatic Colon Cancer ◽  
Unique Case ◽  
Complete Excision ◽  
Additional Chemotherapy ◽  
Folfox Chemotherapy

A 62-year-old man presented with concurrent sigmoid colon adenocarcinoma and small bowel mesenteric dedifferentiated liposarcoma. Following surgical resection of the colon cancer, complete excision of the mesenteric sarcoma and adjuvant folinic acid, fluorouracil and oxaliplatin (FOLFOX) chemotherapy, the patient demonstrated no radiological evidence of disease for more than 2 years. The patient then developed synchronous recurrence of both cancers: the colon cancer metastasised to the liver and a pelvic lymph node, and the liposarcoma recurred in the original location. The patient underwent additional chemotherapy with complete response of the metastatic colon cancer and stable disease for the liposarcoma. The recurrent mesenteric tumour was subsequently resected. Although concurrent cancers have been reported, this unique case of synchronous recurrence raises interesting hypotheses regarding host–tumour interaction and immune surveillance.

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