Imatinib-induced fatal acute liver failure
Ezequiel Ridruejo1, Roberto Cacchione, Alejandra G Villamil
1Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, CEMIC, Avda. Las Heras 2939, Buenos Aires, Argentina. eridruejo@cemic.edu.ar
World Journal of Gastroenterology
|December 29, 2007
Summary
This case study highlights a fatal instance of severe hepatitis linked to imatinib mesylate treatment for chronic myeloid leukemia (CML). Concomitant acetaminophen use may exacerbate imatinib-induced liver injury, underscoring the need for vigilant monitoring.
Area of Science:
- Hepatology
- Oncology
- Pharmacology
Background:
- Imatinib mesylate is a tyrosine kinase inhibitor approved for chronic myeloid leukemia (CML) and gastrointestinal stromal tumors (GIST).
- Severe hepatic toxicity, including fatalities, has been reported with imatinib mesylate treatment.
- The potential for drug-drug interactions exacerbating hepatotoxicity requires further investigation.
Observation:
- A 51-year-old woman with CML developed severe acute hepatitis with coagulopathy five months after initiating imatinib mesylate therapy.
- The patient concurrently used acetaminophen (500-1000 mg/day) following symptom onset.
- Clinical deterioration included rising bilirubin, decreased clotting factor V, and grade II encephalopathy, necessitating liver transplantation referral.
Findings:
- The patient's severe hepatitis and coagulopathy were associated with imatinib mesylate treatment.
- Concomitant acetaminophen use may have contributed to the severity of the hepatotoxicity.
- The patient experienced a fatal cardiac arrest following referral for liver transplantation.
Implications:
- This case underscores the potential for imatinib mesylate-induced hepatotoxicity and liver failure.
- Concomitant use of acetaminophen with imatinib may increase the risk of severe liver injury.
- Close monitoring of liver function tests and prompt discontinuation of imatinib are crucial during treatment.
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