12 January 2014
: Case report
Hepatomegaly and fever at the time of neutrophil recovery revealing L-asparaginase toxicity in the treatment of acute lymphoblastic leukemia
Challenging differential diagnosis, Unusual or unexpected effect of treatment, Rare disease, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)
Julien SaisonABCDEF, Francoise BergerBEF, Fanny LebosseEF, Regis AudoualB, Xavier ThomasADEF, Mauricette MichalletAEDOI: 10.12659/AJCR.889867
Am J Case Rep 2014; 15:13-17
Abstract
Background: L-asparaginase (L-aspa) is an important component of chemotherapy in acute lymphoblastic leukemia (ALL). Main adverse effects of L-aspa include allergic reactions, pancreatitis, thrombosis, and liver disturbances. L-aspa-associated steatohepatitis may be a life-threatening disorder but has very rarely been reported in the literature.
Case Report: ALL was diagnosed in a 52-year-old man with a history of cardiovascular disease and obesity. Chemotherapy combining daunorubicin, vincristine, cyclophosphamide, and L-aspa was initiated. At the time of neutrophil recovery, the patient developed hepatomegaly in the context of fever and cough. On day 25, after 6 injections of L-aspa, liver function tests showed elevated alkaline phosphatase and transaminases levels. Although pulmonary Pneumocystis was concomitantly diagnosed, biological hepatic disturbances were attributed to L-aspa-associated toxicity. A liver biopsy revealed severe diffuse micro- and macrovesicular steatosis affecting more than 50% of hepatocytes. Other causes of liver dysfunction were eliminated. L-aspa and other hepatotoxic treatments were stopped, and treatment with antioxidant therapy, atovaquone, and corticosteroids was initiated. The clinical outcome was rapidly favorable.
Conclusions: This case illustrates the necessity of carefully monitoring liver function test results in patients receiving L-aspa. In case of major increase of hepatic enzymes, a hepatic biopsy should rapidly be performed to exclude differential diagnosis in patients with prolonged neutropenia. L-aspa should be stopped and further administration definitively avoided. In the present case, the early administration of systemic corticosteroids as treatment of the concomitant Pneumocystis with hypoxemia could have participated to the favorable clinical evolution.
Keywords: acute lymphoblastic leukemia, Hepatomegaly, liver steatosis, L-Asparagine, Cholestasis
In Press
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945294
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945747
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945539
Case report
Am J Case Rep In Press; DOI: 10.12659/AJCR.945795
Most Viewed Current Articles
21 Jun 2024 : Case report
88,402
DOI :10.12659/AJCR.944371
Am J Case Rep 2024; 25:e944371
07 Mar 2024 : Case report
49,961
DOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
20 Nov 2023 : Case report
25,080
DOI :10.12659/AJCR.941424
Am J Case Rep 2023; 24:e941424
18 Feb 2024 : Case report
22,629
DOI :10.12659/AJCR.943030
Am J Case Rep 2024; 25:e943030