title: Temozolomide-induced biliary ductopenia: a case report.
abstract: BACKGROUND
  Temozolomide is an alkylating agent used along with concurrent radiation therapy in the treatment of glioblastoma. The primary adverse effect of temozolomide is bone marrow suppression with resulting cytopenias. There have been reported cases of temozolomide-induced hepatotoxicity, including fatal liver failure, associated with reactivation of the hepatitis virus or with concurrent use of other hepatotoxic drugs. In this report, we describe a unique mechanism of temozolomide-induced liver injury with supporting histopathology.
  
  
  METHODS
  Our patient, a 58-year-old African american woman with glioblastoma, was treated with concurrent radiation and temozolomide therapy. After 6 weeks of treatment, she developed worsening transaminitis and bilirubinemia with liver biopsy results consistent with drug-induced cholestasis and ductopenia. After cessation of drug treatment, her hyperbilirubinemia progressed with a peak bilirubin of 36.8 mg/dl. A repeat liver biopsy revealed severe biliary ductopenia consistent with vanishing bile duct syndrome.
  
  
  CONCLUSIONS
  We present a rare case of a patient with biliary ductopenia as an adverse effect of temozolomide. During radiation and temozolomide therapy, blood counts and liver enzymes should be carefully monitored for the development of cholestatic liver injury. We recommend monitoring with weekly liver function tests and minimizing drugs that are metabolized by the liver during chemoradiation for glioblastoma.
authors: Department of Internal Medicine, University of South Florida, Tampa, FL, USA. ashab@health.usf.edu.
authors: Asha
authors: A
authors: Balakrishnan
authors: Department of Internal Medicine, University of South Florida, Tampa, FL, USA. rledford@health.usf.edu.
authors: Robert
authors: R
authors: Ledford
authors: Department of Internal Medicine, University of South Florida, Tampa, FL, USA. michael.jaglal@moffitt.org.|Department of Malignant Hematology, H. Lee Moffitt Cancer and Research Institute, 12902 Magnolia Drive, Tampa, FL, 33612, USA. michael.jaglal@moffitt.org.
authors: Michael
authors: M
authors: Jaglal
mesh_terms: D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects*; D001649:Bile Duct Diseases / Q000139:chemically induced*; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D059248:Chemoradiotherapy; D002779:Cholestasis / Q000139:chemically induced; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D005909:Glioblastoma / Q000628:therapy*; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced; D008875:Middle Aged; D000077204:Temozolomide
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide