Authors: Xiang Shan Ren Kenichi Harada Seiichi Yoshikawa Saya Igarashi Takeshi Urabe Shinya Yamada Kazuyoshi Katayanagi Hiroshi Kurumaya Yasuni Nakanuma
Publish Date: 2010/06/22
Volume: 3, Issue: 4, Pages: 191-194
Abstract
We report the case of an 80yearold female suffering from pancreatic cancer who developed severe nonalcoholic steatohepatitis NASH resulting in fatal hepatic failure after anticancer chemotherapy with gemcitabine Hepatic encephalopathy appeared 1 year after the chemotherapy and the patient developed progressive liver failure and eventually died Radiological examination showed severe fatty liver Histopathological examination of a liver needle necropsy showed almost panlobular macrovesicular fatty change Ballooning degeneration and necrosis of hepatocytes accompanying neutrophil infiltration Mallory bodies and a few bile plugs were found in zone 3 Marked perivenular and pericellular/perisinusoidal fibrosis and extensive bridging fibrosis were also found Together these findings indicated steatohepatitis at a precirrhotic stage Because the patient had no history of drinking in excess we made a diagnosis of NASH in particular chemotherapyassociated steatohepatitis CASH Gemcitabine is a pyrimidine nucleoside antimetabolite with anticancer activity A few reports have mentioned fatal hepatotoxicity caused by gemcitabine but to our knowledge this is the first report of steatohepatitis possibly associated with gemcitabine Physicians treating patients with this drug should be aware of the possibility of steatohepatitis
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