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A case of fatal acute liver failure in a 68 year old female treated with erlotinib for lung adenocarcinoma

Cyrielle Jardin, Arnaud Desplechin, Julie Delourme, Xavier D'Halluin, Arnaud Scherpereel, Jean-Jacques Lafitte, Alexis Cortot
European Respiratory Journal 2012 40: P1245; DOI:
Cyrielle Jardin
1Service de Pneumo-Immuno-Allergologie, Hôpital Calmette, CHRU, Lille, France
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Arnaud Desplechin
3Service d'Onco-Hématologie, Hôpital Saint Vincent de Paul, Lille, France
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Julie Delourme
2Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU, Lille, France
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Xavier D'Halluin
2Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU, Lille, France
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Arnaud Scherpereel
2Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU, Lille, France
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Jean-Jacques Lafitte
2Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU, Lille, France
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Alexis Cortot
2Service de Pneumologie et Oncologie Thoracique, Hôpital Calmette, CHRU, Lille, France
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Abstract

A 68 year old female with a history of levothyroxine-substituted hypothyroidism was diagnosed with metastatic lung adenocarcinoma. She was treated with 3 courses of a platinum-based chemotherapy as first-line treatment and docetaxel as second-line treatment. She received daily injections of fondaparinux because of a recent pulmonary embolism. Despite these treatments, the patient developed lymphangitic carcinomatosis and brain metastasis, and erlotinib was initiated. 18 days later, she was admitted at the emergency room for vomiting and dehydration. Clinical findings included mild abdominal pain in the upper right quadrant. Blood tests showed elevated liver enzymes (AST 7900 IU/L (N<40), ALT 9200 IU/L (N<40) and acute liver failure (32% PT, 13% factor V). Paracetamol blood level was negative, as well as HIV, EBV, VZV, CMV and hepatitis A, B and C tests. Abdominal ultrasound showed no obstruction on the biliary tract, no portal thrombosis. The patient rapidly developed metabolic encephalopathy, leading to her death within 18 hours after admission. Careful interrogation of her relatives and general practitioner did not reveal medications other than erlotinib, levothyroxine and fondaparinux. Previous liver blood tests during chemotherapy were normal. Acute liver failure due to erlotinib was then considered as the probable cause of death.

  • Lung cancer / Oncology
  • Treatments
  • © 2012 ERS
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A case of fatal acute liver failure in a 68 year old female treated with erlotinib for lung adenocarcinoma
Cyrielle Jardin, Arnaud Desplechin, Julie Delourme, Xavier D'Halluin, Arnaud Scherpereel, Jean-Jacques Lafitte, Alexis Cortot
European Respiratory Journal Sep 2012, 40 (Suppl 56) P1245;

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A case of fatal acute liver failure in a 68 year old female treated with erlotinib for lung adenocarcinoma
Cyrielle Jardin, Arnaud Desplechin, Julie Delourme, Xavier D'Halluin, Arnaud Scherpereel, Jean-Jacques Lafitte, Alexis Cortot
European Respiratory Journal Sep 2012, 40 (Suppl 56) P1245;
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