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Related Experiment Videos

Thalidomide-induced severe hepatotoxicity.

A James Hanje1, Jennifer L Shamp, Fred B Thomas

  • 1Department of Internal Medicine, Division of Digestive Health, The Ohio State University, Columbus, Ohio, USA. jim.hanje@osumc.edu

Pharmacotherapy
|June 29, 2006
PubMed
Summary
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Thalidomide can cause rare but severe liver injury (hepatotoxicity) in multiple myeloma patients. Prompt discontinuation of thalidomide led to significant improvement in liver function tests.

Area of Science:

  • Hepatology
  • Oncology
  • Pharmacology

Background:

  • Thalidomide is a recognized treatment for advanced, refractory multiple myeloma.
  • Hepatotoxicity is an extremely rare adverse effect associated with thalidomide therapy.
  • This case highlights a severe instance of drug-induced liver injury.

Observation:

  • A 76-year-old woman with multiple myeloma developed acute liver injury after 6 weeks of thalidomide and dexamethasone treatment.
  • Her liver enzymes (AST and ALT) increased over 50 times the normal limit.
  • Liver biopsy revealed acute injury with steatosis and fibrosis, indicating undiagnosed nonalcoholic steatohepatitis.

Findings:

  • Discontinuation of thalidomide resulted in a rapid downward trend of liver enzyme levels.

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  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels significantly improved within 7 days.
  • This case, along with other reports, confirms severe hepatotoxicity as a rare but serious thalidomide complication.

    • Implications:

    • Clinicians should be vigilant for severe hepatotoxicity as a potential complication of thalidomide therapy.
    • The expanding use of thalidomide necessitates increased awareness of its rare but serious adverse effects.
    • Further research is needed to determine if patients with pre-existing liver disease are at higher risk.