An unusual cause of jaundice… (or is it?)
November 15th, 2008
A 38 year old female is diagnosed with breast cancer and having had a lumpectomy proceeds to have 6 cycles of chemotherapy.
PMHx: Asthma, Previous Intravenous drug user
SHx: Current smoker
She does not attend for her pre op chemotherapy clinic appointment, but nevertheless goes on to have the chemotherapy.
6 weeks into her chemotherapy treatment she becomes jaundiced and has the blood tests taken
The problem has not arisen as a result of an adverse drug reaction.
What is the most likely underlying problem that has caused her to be jaundiced?
Acute hepatitis
Unlikely to be a viral hepatitis
Lymphatic obstruction seems to be logical but it doesn’t fit with the LFT’s
That Looks hepatitic rather than obstructive…
G
this is a ‘hepatitic’ picture with not obstructive
could still be a viral hepatitis if they have had chemo and they are immunosupressed
this most likely if no other cause found
check hepatitis b and hepatitis c serology and liver consult
agree with above management. pcr for hepatitis virus
anthracycline chemotherapy based toxicity
Thanks Mike, it is a bit of an unfair one this! We thought we’d let people debate it for a while. Hepatitis B and C can both be reactivated, in this case its most likely dormant hepatitis B. To quote the review from Nature
“HBV reactivation is common in patients who receive chemotherapy, immunosuppressive therapy, or other cytotoxic agents. Prophylaxis for HBV reactivation with lamivudine has shown promising efficacy, however, when prophylaxis should be given, to whom and for how long is unclear.”
Essentially the bottom line is you need to start antivirals in this population prior to getting Hep B, and continue them for at least 12 months.
Read more at the following link:
http://www.nature.com/nrgastro/journal/v4/n3/full/ncpgasthep0740.html