[Budd-Chiari syndrome during treatment with dacarbazine (DTIC) (author's transl)]

Adjuvant chemo- and immuno-therapy with dacarbazine (1st to 5th day 250 mg/m2 daily) and BCG (6th day 0.01 ml intracutaneously)was administered to a 50-year-old male patient in a three-week cycle after surgical removal of a superficially spreading malignant melanoma. Metoclopramide was used as an antiemetic. During the second therapy cycle sudden severe vascular collapse with increasing hepatomegaly and signs of acute hepatic failure occurred leading to death after two days. At necropsy a Budd-Chiari syndrome with thombosed hepatic veins and congestive liver parenchyma necroses was found. The cause was hyperergic endophlebitis combined with severe infiltration of the vascular walls by eosinophilic granulocytes. In association with 5 more similar cases from other clinics (personal communications) this picture must be assumed to be a complication of dacarbazine treatment.