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Sunitinib, a cancer drug, can cause hyperammonemic encephalopathy, a rare brain condition. Early identification and lactulose treatment are crucial for patients presenting with altered mental status.

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Area of Science:

  • Oncology
  • Neurology
  • Emergency Medicine

Background:

  • Sunitinib is a tyrosine kinase inhibitor used for various cancers.
  • Rare adverse effects of cancer therapies are increasingly recognized as patients live longer.
  • Hyperammonemic encephalopathy is a serious neurological condition characterized by elevated ammonia levels in the blood.

Observation:

  • A 71-year-old woman with metastatic breast cancer developed confusion after 12 days of sunitinib treatment.
  • Emergency department workup revealed significantly elevated ammonia levels (202 μmol/L) without underlying liver disease.
  • The patient's mental status and ammonia levels fluctuated during a 12-day hospitalization despite lactulose treatment.

Findings:

  • This case represents the first reported instance of sunitinib-associated hyperammonemic encephalopathy in emergency medicine literature.
  • Magnetic resonance imaging and electroencephalogram results were unremarkable, ruling out other neurological causes.
  • Ammonia levels normalized, and neurological symptoms resolved after discontinuing sunitinib, with no recurrence at three months follow-up.

Implications:

  • Clinicians should consider sunitinib-induced hyperammonemic encephalopathy in patients presenting with altered mentation.
  • Prompt measurement of ammonia levels and initiation of lactulose are recommended for early diagnosis and management.
  • Awareness of this rare adverse effect is critical for preventing severe complications like seizures, brain edema, and death.