A Case of Imatinib-Induced Hepatitis
Osman Bhatty1, Mohammad Selim2, Thamer Kassim3
1Internal Medicine, Creighton University.
Cureus
|July 11, 2017
Summary
Imatinib, a treatment for chronic myelogenous leukemia, can cause severe liver damage. Stopping the drug improved symptoms, but the patient later developed liver and kidney failure, leading to palliative care.
Area of Science:
- Hepatology
- Oncology
- Pharmacology
Background:
- Philadelphia chromosome-positive chronic myelogenous leukemia (Ph+ CML) is a myeloproliferative neoplasm.
- Imatinib is a tyrosine kinase inhibitor commonly used for Ph+ CML treatment.
- Drug-induced liver injury (DILI) is a significant concern in patients on long-term medication.
Observation:
- A 71-year-old female with Ph+ CML on imatinib presented with acute hepatitis.
- Initial workup excluded viral, infectious, and metabolic causes.
- Imatinib cessation led to immediate, albeit temporary, improvement in liver function.
Findings:
- Liver biopsy confirmed drug-induced liver damage consistent with imatinib toxicity.
- Despite initial improvement and prednisone treatment, the patient experienced progressive hepatic and renal failure.
- Deterioration included gastric bleeding, acute kidney injury, and cellulitis, necessitating a palliative care approach.
Implications:
- This case highlights the potential for severe, progressive liver and kidney toxicity from imatinib, even after drug withdrawal.
- It underscores the importance of vigilant monitoring for DILI in patients receiving imatinib therapy.
- The case also illustrates a rare but devastating progression of DILI leading to multi-organ failure and the need for early consideration of palliative care in complex cases.
