Fas ligand-mediated lethal hepatitis after rapid lysis of a localized natural killer cell lymphoma.
Natural killer (NK) cell malignancies have been associated with neutropenia and disturbances of liver function tests, thought to be related to high levels of soluble Fas ligand (FasL) in the circulation. We report a case of fulminant hepatitis occurring 3 weeks after the initiation of salvage therapy by arginine butyrate and ganciclovir for refractory Epstein-Barr virus-positive NK cell lymphoma. Pathologic examination revealed disappearance of the NK tumor and massive liver injury caused by apoptosis of virtually all hepatocytes. Immunohistochemistry revealed an intense staining for FasL. To our knowledge, this is the first description of the occurrence of FasL-mediated lethal hepatitis after lysis of a NK cell lymphoma.
Ghez
David
D
Service d'Hematologie, Hopital Necker, Paris, France.
Damotte
Diane
D
Perrine
Susan P
SP
Faller
Douglas V
DV
Canioni
Danièle
D
Brousse
Nicole
N
Lefrère
François
F
Varet
Bruno
B
Hermine
Olivier
O
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001120:Arginine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use; D002087:Butyrates / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology / Q000473:pathology*; D018450:Disease Progression; D053222:Fas Ligand Protein; D017809:Fatal Outcome; D005260:Female; D015774:Ganciclovir / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007694:Killer Cells, Natural / Q000473:pathology*; D008223:Lymphoma / Q000188:drug therapy* / Q000473:pathology*; D008562:Membrane Glycoproteins; D008875:Middle Aged; D012720:Severity of Illness Index; D048069:Tumor Necrosis Factors
D002087:Butyrates; C505661:FASLG protein, human; D053222:Fas Ligand Protein; D008562:Membrane Glycoproteins; D048069:Tumor Necrosis Factors; D001120:Arginine; C033018:arginine butyrate; D015774:Ganciclovir