Obstructive Jaundice Due to Duodenal Ulcer Induced by Lenvatinib Therapy for Hepatocellular Carcinoma

An 82-year-old man with hepatocellular carcinoma presented with upper abdominal pain, vomiting, and jaundice. He had been taking a standard lenvatinib dose for three months. Although acute cholangitis was suggested, imaging studies failed to detect the biliary obstruction site. An endoscopic examina...

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Bibliographic Details
Published in:Internal Medicine 2021/02/15, Vol.60(4), pp.545-552
Main Authors: Suoh, Maito, Hagihara, Atsushi, Yamamura, Masafumi, Maruyama, Hirotsugu, Taira, Koichi, Enomoto, Masaru, Tamori, Akihiro, Fujiwara, Yasuhiro, Kawada, Norifumi
Format: Article
Language:English
Subjects:
Aged, 80 and over
Ampulla of Vater
Antibiotics
Aspirin
Bacteremia
Carcinoma, Hepatocellular - drug therapy
Case Report
Cholangitis
Cholestasis
duodenal ulcer
Duodenal Ulcer - chemically induced
Duodenal Ulcer - diagnosis
Endoscopy
Hepatocellular carcinoma
Humans
Internal medicine
Jaundice
Jaundice, Obstructive - chemically induced
lenvatinib
Liver cancer
Liver Neoplasms - drug therapy
Male
Misoprostol
obstructive jaundice
Phenylurea Compounds
Quinolines
Ulcers
Vomiting
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Summary:An 82-year-old man with hepatocellular carcinoma presented with upper abdominal pain, vomiting, and jaundice. He had been taking a standard lenvatinib dose for three months. Although acute cholangitis was suggested, imaging studies failed to detect the biliary obstruction site. An endoscopic examination following discontinuation of lenvatinib and aspirin revealed multiple duodenal ulcers, one of which was formed on the ampulla of Vater and causing cholestasis. Endoscopic biliary drainage and antibiotics improved concomitant Enterobacter cloacae bacteremia. Ulcer healing was confirmed after rabeprazole was replaced with vonoprazan and misoprostol. Our case shows that lenvatinib can induce duodenal ulcers resulting in obstructive jaundice.
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.5097-20