title: A case report: delayed high fever and maculopapules during Sorafenib treatment of ectopic hepatocellular carcinoma.
abstract: Sorafenib is the standard first-line therapy for hepatocellular carcinoma (HCC) and probably ectopic hepatocellular carcinoma (EHCC) as well. No report involves a side effect of delayed high fever of sorafenib. This manuscript describes a case of EHCC in the thoracic and abdominal cavities, who showed a delayed high fever and maculopapules during sorafenib treatment.
  
  
  
  The patient is a 63-year-old Chinese male with advanced EHCC, taking sorafenib 400 mg twice daily. On the tenth day, red maculopapules appeared all over the body. On the same day, the patient began to suffer from continuous high fever. Due to these effects, the patient was asked to cease sorafenib treatment, and the high fever and maculopapules were alleviated quickly. However, the symptoms were present again upon re-challenge of sorafenib. Prednisone was then administered to control the symptoms, with the dosage gradually reduced from 30 to 5 mg/day in 1.5 months. No recurrence of fever or maculopapules has been found. Tumor response reached partial response (PR) and progression free survival (PFS) reached 392 days + by the date of Apr. 14th, 2016.
  
  
  
  EHCC could be treated like orthotopic HCC by oral administration of sorafenib, which shows good tumor response and survival benefit. Delayed high fever and maculopapules are potential, rare and severe side effects of sorafenib, and could be effectively controlled by glucocorticoid.
authors.affiliation: Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
authors.forename: Tianxiang
authors.initials: T
authors.lastname: Cui
authors.affiliation: Department of pathology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
authors.forename: Xinwei
authors.initials: X
authors.lastname: Diao
authors.affiliation: Medical English Department, College of Basic Medicine, Third Military Medical University, Chongqing, 400038, China.
authors.forename: Xiewan
authors.initials: X
authors.lastname: Chen
authors.affiliation: Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China.
authors.forename: Shaojiang
authors.initials: S
authors.lastname: Huang
authors.affiliation: Cancer Institute of PLA, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037, China. sunjg09@aliyun.com.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Sun
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000188:drug therapy; D003875:Drug Eruptions / Q000150:complications / Q000188:drug therapy*; D005334:Fever / Q000139:chemically induced*; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010671:Phenylurea Compounds / Q000008:administration & dosage* / Q000009:adverse effects; D011241:Prednisone / Q000008:administration & dosage / Q000627:therapeutic use; D000077157:Sorafenib; D016896:Treatment Outcome
chemical_list: D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D011241:Prednisone
keywords: Delayed reaction; Ectopic hepatocellular carcinoma; High fever; Maculopapules; Sorafenib