Imatinib mesylate-induced acute liver failure in a patient with gastrointestinal stromal tumors.
Imatinib mesylate is a drug that has been approved for treatment of chronic myeloid leukemia, Philadelphia-positive acute lymphoblastic leukemia, and advanced gastrointestinal stromal tumors. Several cases of hepatotoxicity, including fatal liver failure, have been reported with the long-term use of imatinib mesylate. Generally hepatotoxicity resolves after discontinuation of imatinib. Despite discontinuation of imatinib, hepatotoxicity can be progressive. Steroid may be useful in these patients and should be started early. We report a 53-year-old woman with advanced gastrointestinal stromal tumors who developed hepatotoxicity while receiving imatinib and subsequently acute liver failure. Ten weeks after commencing imatinib treatment, hepatotoxicity was determined. Imatinib was immediately ceased. Subsequently, a week later hepatic encephalopathy, jaundice, and coagulopathy occurred. Prednisolone was commenced. Liver biopsy was performed five weeks after the determining of hepatotoxicity. Biopsy showed sinusoidal congestion, necrosis of hepatocytes, inflammation, and hepatocyte drop out around the hepatic venule consistent with drug toxicity. Her liver function tests normalized with a nine-week prednisolone treatment. The patient was discharged. Her liver enzymes remained in normal range following visits. In cases of imatinib-induced acute hepatitis, the administration of prednisolone may be useful in the resolution of the acute episode and allow the reintroduction of a drug without risking recurrence of hepatitis.
Tonyali
Onder
O
Faculty of Medicine, Department of Medical Oncology, Gazi University, 06500, Besevler Ankara, Turkey.
Coskun
Ugur
U
Yildiz
Ramazan
R
Karakan
Tarkan
T
Demirci
Umut
U
Akyurek
Nalan
N
Benekli
Mustafa
M
Buyukberber
Suleyman
S
D000208:Acute Disease; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001549:Benzamides; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D046152:Gastrointestinal Stromal Tumors / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D006801:Humans; D000068877:Imatinib Mesylate; D007211:Indoles / Q000627:therapeutic use; D007414:Intestinal Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D008099:Liver / Q000473:pathology; D017093:Liver Failure / Q000139:chemically induced* / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000556:secondary; D010879:Piperazines / Q000009:adverse effects* / Q000627:therapeutic use; D011239:Prednisolone / Q000627:therapeutic use; D047428:Protein Kinase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects* / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D000077210:Sunitinib
D000893:Anti-Inflammatory Agents; D000970:Antineoplastic Agents; D001549:Benzamides; D007211:Indoles; D010879:Piperazines; D047428:Protein Kinase Inhibitors; D011743:Pyrimidines; D011758:Pyrroles; D000068877:Imatinib Mesylate; D011239:Prednisolone; D000077210:Sunitinib