Life-threatening acute acalculous cholecystitis in a patient with renal cell carcinoma treated by sunitinib: a case report

Abstract

IntroductionSunitinib, an oral multitargeted tyrosine kinase inhibitor, is widely used in the treatment of renal cell carcinoma and gastrointestinal stromal tumor and has had a variety of adverse events. However, sunitinib-related acute cholecystitis has been reported in only two patients with gastrointestinal stromal tumor and renal cell carcinoma (clear cell subtype).Case presentationA 75-year-old Japanese woman with a right sided abdominal swelling was referred to our hospital. Computed tomography (CT) showed a hypervascular bulky tumor in her right kidney, suggesting right renal cell carcinoma in clinical T4N0M0. Although sunitinib therapy was started as neoadjuvant chemotherapy, during the fourth week of the first cycle, she developed acute acalculous cholecystitis and disseminated intravascular coagulation associated with sunitinib. Sunitinib therapy was discontinued immediately and she recovered after subsequent treatment with antibiotics and gabexate mesilate followed by percutaneous cholecystostomy. Cholecystectomy and right radical nephrectomy were performed and pathological examination showed that her renal tumor was a chromophobe renal cell carcinoma (pT2) with necrosis. Inflammation and ischemia were observed in the gallbladder wall, which was compatible with acute acalculous cholecystitis. There has been no evidence of disease recurrence for more than six months.ConclusionWe described the third case of sunitinib-related acute cholecystitis in a patient with chromophobe renal cell carcinoma. Attention is required to sunitinib-related acute cholecystitis which, while uncommon, could be life-threatening.

Acute Acalculous Cholecystitis in a Patient with Metastatic Renal Cell Carcinoma Treated with Sunitinib

“…2-4 All three presented with acalculous cholecystitis, which is an acute necroinflammatory disease of the gallbladder associated with high morbidity and mortality. Known risk factors for its development are sepsis, parenteral nutrition, opiates and conditions leading to immunosuppression.…”

“…Sunitinib-related acute cholecystitis has been previously reported in three patients: one with gastrointestinal stromal tumors, one with clear-cell renal carcinoma, and one with cromophobe RCC. 2-4 All three presented with acalculous cholecystitis, which is an acute necroinflammatory disease of the gallbladder associated with high morbidity and mortality. Known risk factors for its development are sepsis, parenteral nutrition, opiates and conditions leading to immunosuppression.…”

Acute Acalculous Cholecystitis in Patients With Clear Cell Renal Cell Carcinoma Treated With Sunitinib: Report of Two Cases

“…In the previous literature, only three cases of sunitinib-related acute cholecystitis have been reported, including one patient with a GIST [ 3 ] and two patients with RCC [ 4 , 5 ]. The Naranjo adverse drug reaction probability scale scores for these events were 6 and 5, respectively, indicating the probable association of these events with sunitinib treatment [ 6 ].…”

Management of VEGFR-Targeted TKI for Thyroid Cancer

“…Acute cholecystitis has been reported as an adverse event associated with anti-VEGFR TKIs across tumor types [ 108 , 109 , 110 , 111 , 112 , 113 ], but its mechanism remains unclear. One candidate is microvascular ischemia and imbalance in stress adaptation, via the inhibition of VEGF signaling in cholangiocytes expressing VEGFRs.…”