[Acute liver injury with hepatic encephalopathy associated with gemcitabine administration for adjuvant chemotherapy in an HBV carrier with pancreatic cancer].
A 75-year-old woman was admitted to our department because of epigastric pain. Imagings revealed cancer of the head of the pancreas. She was an HBV carrier, although no liver dysfunction was observed. Her serum HBV-DNA level was lower than 2.6. We performed pancreaticoduodenectomy for pancreatic cancer. No postoperative complication was observed. The histopathological diagnosis was tubular adenocarcinoma of the pancreas. As a postoperative adjuvant chemotherapy, gemcitabine hydrochloride (GEM) was injected at a dose of 800mg/m2 once a week. Disorientation and jaundice were observed after six doses of GEM. Blood chemistry revealed that total bilirubin and ammonia were abnormally elevated, and that blood coagulant factors were diminished. Serum HBV-DNA level was lower than 2.6. It showed no reactivation of HBV. Abdominal CT showed no recurrence but fatty liver. Fresh frozen plasma was supplied and branched chain amino acids were injected after GEM was administration discontinued. Lactulose was also given orally. With these conservative treatments, she recovered completely. Careful monitoring of liver function during GEM administration is required in a HBV carrier.
Tanaka
Hiroshi
H
Dept. of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Japan.
Takamori
Hiroshi
H
Eto
Shin-ichiro
S
Ozaki
Nobuyuki
N
Akaboshi
Shin-ichi
S
Nakahara
Osamu
O
Ida
Satoshi
S
Furuhashi
Satoshi
S
Abe
Shinya
S
Horino
Kei
K
Beppu
Toru
T
Baba
Hideo
H
D000208:Acute Disease; D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006501:Hepatic Encephalopathy / Q000139:chemically induced* / Q000188:drug therapy; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D008099:Liver / Q000293:injuries*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D000093542:Gemcitabine
D000597:Amino Acids, Branched-Chain; D003841:Deoxycytidine; D007792:Lactulose; D000093542:Gemcitabine