title: Fulminant hepatitis in a patient with hepatocellular carcinoma related to nonalcoholic steatohepatitis treated with sorafenib.
abstract: We describe a case of acute liver failure in a patient with advanced hepatocellular carcinoma related to nonalcoholic steatohepatitis during sorafenib treatment. A 74-year-old man with diabetes mellitus and hypertension was diagnosed with hepatocellular carcinoma associated with fatty liver. Three weeks after sorafenib therapy, at Eastern Cooperative Oncology Group performance status 3, he developed jaundice, general weakness, flapping tremor, nausea, and anorexia. Sorafenib was stopped: laboratory tests showed a relevant elevation of transaminases suggesting diagnosis of acute hepatitis. During hospital admission, the patient died of liver failure. Sorafenib is the first successful target therapy effective for advanced hepatocellular carcinoma. The most common adverse events are fatigue, hand-foot skin reaction, skin rash/desquamation, diarrhea, and hypertension, whereas liver dysfunction is uncommon. To our knowledge, this is the first patient reported in the literature with hepatocellular carcinoma related to nonalcoholic steatohepatitis who died of rapid worsening of liver function during sorafenib treatment.
authors.affiliation: 1 Department of Experimental, Diagnostic and Specialty Medicine, Sant'Orsola Malpighi Hospital, University of Bologna, Bologna - Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Brandi
authors.forename: Stefania
authors.initials: S
authors.lastname: De Lorenzo
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Girolamo
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellentani
authors.forename: Gioconda
authors.initials: G
authors.lastname: Saccoccio
authors.forename: Guido
authors.initials: G
authors.lastname: Biasco
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D017809:Fatal Outcome; D006801:Humans; D007565:Jaundice / Q000209:etiology; D017114:Liver Failure, Acute / Q000139:chemically induced / Q000150:complications / Q000209:etiology* / Q000503:physiopathology; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D018908:Muscle Weakness / Q000209:etiology; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications*; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000077157:Sorafenib; D014057:Tomography, X-Ray Computed; D014202:Tremor / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib