Resected Hepatocellular Carcinoma in a Patient with Crohn’s Disease on Azathioprine

Abstract

Hepatocellular carcinoma rarely occurs in patients without underlying cirrhosis or liver disease. While inflammatory bowel disease has been linked to certain forms of liver disease, hepatocellular carcinoma is exceedingly rare in these patients. We report the twelfth case of hepatocellular carcinoma in a patient with Crohn’s disease. The patient is a 61-year-old with longstanding Crohn’s disease who was treated with azathioprine and was found to have elevated liver enzymes and a new 3-cm liver mass on ultrasound. A complete workup for underlying liver disease was unremarkable and liver biopsy revealed hepatocellular carcinoma. The patient underwent a hepatic resection, and there is no evidence of recurrence at the 11-month follow-up. The resection specimen showed no evidence of cancer despite the initial biopsy revealing hepatocellular carcinoma. This case represents the third biopsy-proven complete spontaneous regression of hepatocellular carcinoma. Although large studies have failed to show a definite link between azathioprine and hepatocellular carcinoma, the relationship remains concerning given the multiple case reports suggesting a possible association. Clinicians should exercise a high degree of suspicion in patients with Crohn’s disease who present with elevated liver enzymes, especially those on azathioprine therapy.

Network Crosstalk as a Basis for Drug Repurposing

“…Azathioprine is an immunosuppressant used to prevent renal transplant rejection as well as in treatment of autoimmune disorders, such as Crohn’s disease and rheumatoid arthritis. Although a conclusive link between azathioprine and HCC has never been established, multiple case reports suggest a possible association ( Heron et al, 2016 ). This finding exemplifies a case when the uncovered drug–disease combination is of a potential side effect nature rather than a treatment effect, which is usually desired.…”

Hepatocellular Carcinoma in a Patient With Crohn’s Disease

“…This case presents important clinical issues that HCC can occur in patients with CD, even without underlying liver diseases for HCC. The occurrence of HCC among patients with CD is extremely rare, with only 15 cases, including our case, published as case reports in the literature [2][3][4][5][6][7][8][9][10][11][12][13][14][15].…”

The role of sex steroid hormones in Crohn\'s disease

“…46 However, this combination is associated with relevant side effects, such an increased risk of lymphoma development and serious infections. 46,55 Not only the long-term use of this drug may predispose to other complications such as liver cirrhosis, 56 hepatocellular carcinoma, 57 pancreatitis, polyarthritis or panniculitis syndrome (PPP), 58 but also the early administration of AZA may increase the adverse effects of this therapy, with no improvement on management. 59,60 Furthermore, patients who use two concomitant…”