Fulminant hepatic failure resulting from small-cell lung cancer and dramatic response of chemotherapy
2006; Baishideng Publishing Group; Volume: 12; Issue: 15 Linguagem: Inglês
10.3748/wjg.v12.i15.2466
ISSN2219-2840
Autores Tópico(s)Polyomavirus and related diseases
ResumoFHF that improved after chemotherapy. Case reportA 69-year-old male was admitted to our hospital because of a 2-wk history of nausea, anorexia, fatigue, jaundice, and pain in the right upper quadrant of the abdomen.He had no history of blood transfusion, hepatitis, intravenous drug use, or alcohol abuse, though had an average of 2 packs of cigarettes a day for 50 years.Physical examination revealed hepatomegaly and bilateral pretibial edema, but he was alert.Laboratory analyses revealed 1760 U/L alkaline phosphatase, 6695 U/L lactate dehydrogenase (LDH), 470 U/L aspartate aminotransferase (AST), 7.6 mg/dL bilirubin, 85 μg/dL ammonia, prothrombin time level of 63%, and 680 ng/mL neuron specific enolase (NSE) levels.A computed tomography (CT) of the abdomen showed multiple lesions and massive infiltration throughout the liver parenchyma (Figure 1A).A chest roentgenogram and CT scan showed a right hilar mass with pleural effusion (Figure 1B).Bronchoscopy with transbronchial lung biopsy revealed small-cell carcinoma of the lung (Figure 2).On the seventh day of hospitalization, chemotherapy was initiated with carboplatin (area under the curve 4) administered on d 1, and 80 mg/m 2 etoposide from d 1 to 3, with cycles repeated every 3 wk.After two cycles of chemotherapy, the patient felt symptomatically better, and a CT of the chest and abdomen revealed a marked reduction of tumor size in the primary site and liver metastasis.The laboratory analyses revealed an improvement of hepatic failure.During the 2 months of initial chemotherapy, the patient's condition deteriorated due to progression of hepatic failure (total bilirubin level, 19.5 mg/dL; LDH, 4 699 U/L; AST, 424 U/L; ammonia, 145 μg/dL; glucose, 129 mg/dL; prothrombin time, 38%), the development of ascites, and stage II encephalopathy.A CT scan of the brain revealed no evidence of cerebral metastatic disease.However, the radiological examination revealed the recurrence of SCLC.Therefore, the patient was treated with 35 mg/m 2 amrubicin from d 1 to 3, with cycles repeated every 3 wk.Though grade 4 neutropenia (NCI-CTC ver 2.0) occurred after two cycles of chemotherapy, the patient had a marked improvement of encephalopathy (stage 0), general condition, and laboratory values (LDH, 180 U/L; AST, 45 U/L; ammonia, 42 μg/dL; prothrombin time 89%; and NSE, 9.6 ng/mL).Follow-up CT imaging documented a good partial response of the liver metastases, and a complete disappearance of the right hilar mass.Then,
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