title: Bicalutamide-induced hepatotoxicity: A rare adverse effect.
abstract: METHODS
  Male, 81 FINAL DIAGNOSIS: Prostate cancer Symptoms: Anorexia • dark urine • joundice • letargy
  
  
  METHODS
  Casodex Clinical Procedure: - Specialty: Oncology.
  
  
  OBJECTIVE
  Adverse events of drug therapy.
  
  
  BACKGROUND
  Bicalutamide is a nonsteroidal anti-androgen used extensively during the initiation of androgen deprivation therapy with a luteinizing hormone-releasing hormone (LHRH) agonist to reduce the symptoms of tumor flare in patients with metastatic prostate neoplasm. It can cause gynecomastia, hot flashes, fatigue, and decreased libido through competitive androgen receptor blockade. Although not as common, acute drug-induced liver injury is also possible with bicalutamide therapy. Typically, this results in transient derangement of liver function and patients remain asymptomatic. We share our experience with a case of symptomatic acute hepatotoxicity secondary to the use of bicalutamide and use this opportunity to present a brief review of existing literature.
  
  
  METHODS
  An 81-year-old African American male with metastatic prostate neoplasm presented with nonspecific symptoms along with jaundice of 1-day duration. He was started on a trial of bicalutamide 3 weeks prior to presentation. On physical examination, scleral icterus was noted. Workup revealed acutely elevated liver transaminases (>5 times the upper limit of normal), alkaline phosphatase, conjugated hyperbilirubinemia, and coagulopathy. Other etiologies, including viruses, common toxins, drugs, autoimmune, and copper-induced hepatitis, were considered. Bicalutamide was discontinued and the patient was managed with supportive care. He showed improvement of clinical and laboratory abnormalities within days.
  
  
  CONCLUSIONS
  While rare, clinically significant and potentially life-threatening liver injury can result from use of bicalutamide. Prompt recognition and discontinuation of bicalutamide is necessary to avoid serious complications from this adverse reaction.
authors: Department of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, U.S.A.
authors: Salwa
authors: S
authors: Hussain
authors: Department of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, U.S.A.
authors: Abdallah
authors: A
authors: Haidar
authors: Department of Internal Medicine, Providence Hospital and Medical Centers, Southfield, MI, U.S.A.
authors: Robert E
authors: RE
authors: Bloom
authors: Department of Internal Medicine, Division of Gastroenterology, Providence Hospital and Medical Centers, Southfield, MI, U.S.A.
authors: Nafea
authors: N
authors: Zayouna
authors: Department of Internal Medicine, Division of Gastroenterology, Providence Hospital and Medical Centers, Southfield, MI, U.S.A.
authors: Michael H
authors: MH
authors: Piper
authors: Department of Internal Medicine, Division of Gastroenterology, Henry Ford Health System, Detroit, MI, U.S.A.
authors: Syed-Mohammed R
authors: SM
authors: Jafri
keywords: Drug-Induced Liver Injury; Nonsteroidal Anti-Androgens; Prostatic Neoplasms