Thalidomide‐associated hepatitis: A case report

Abstract

We report a case of hepatitis in a 58-year-old woman being treated with thalidomide for end-stage plasma cell leukemia. The patient had a medical history including chronic stable hepatitis C infection. At diagnosis there was a severe anemia, thrombocytopenia, hypercalcemia, IgG paraproteinemia, peripheral blood myeloma cells, and a marrow plasmacytosis with lytic bony lesion. The disease was refractory to standard chemotherapy, and she was treated with oral thalidomide. Within 1 week she became jaundiced and developed a marked transaminitis. This promptly resolved upon cessation of thalidomide alone. Thalidomide has recently enjoyed renewed interest as a treatment in many disorders, including plasma cell leukemia. To our knowledge, this is the first reported case of thalidomide-associated hepatotoxicity. Although the mechanism of its actions on the liver are uncertain, it is possible that thalidomide acts as a direct hepatotoxin or as an immuno-modulator, altering the activity of chronic viral hepatitis. We present this case to increase awareness of a new potential side effect of thalidomide as its clinical indications expand. Am. J. Hematol. 66:300-302, 2001.

Common and rare side‐effects of low‐dose thalidomide in multiple myeloma: focus on the dose‐minimizing peripheral neuropathy

“…We reported a case of hepatic toxicity. Contrary to the previous two cases reported in the literature (one with chronic asymptomatic hepatitis C infection) (29, 30), we did not observe elevated transaminase levels but only a marked rise in bilirubin level which did not decline to normal value 1 yr after thalidomide withdrawal as in the other two published cases. Although the liver biopsy showed findings consistent with toxic cholestatic hepatitis, we have no definite proof of unique thalidomide liability.…”

“…Regarding DVT, the frequency that was found in our study (7%) was similar to that of thalidomide alone (1), plus dexamethasome (4, 5) or plus chemotherapy (11), whereas it was remarkably lower than the 20% reported by Munshi et al (28) and Hussein et al (29). No DVT was observed by Grover et al (24) using high‐dose thalidomide for a long time, strengthening the hypothesis that DVT is not associated with thalidomide dose alone but also with other factors such as chemotherapy or large bulk disease.…”

Thalidomide-Induced Severe Hepatotoxicity

“…Another case report involved a 56-year-old woman with previously diagnosed chronic hepatitis C who was treated with thalidomide for refractory multiple myeloma. 16 She developed jaundice and liver function test abnormalities 6 days after the start of therapy.…”

Використання Комбінованого Гепатопротектора “Гепадиф” Для Комплексного Лікування Та Профілактики Токсичного Гепатиту В Пацієнтів Із Гемобластозами

“…Токсичні гепатити можуть розвиватися внаслідок при-йому циклофосфаміду (ендоксану), l-аспарагінази, іда-рубіцину, а також одного із сучасних протипухлинних препаратів -талідоміду [7,15]. У гематології застосову-ють також імунодепресанти, зокрема циклоспорин, які викликають токсичне ураження печінки.…”

“…До складу гепадифу входить і вітамінний комплекс групи В, завдяки якому препарат бере участь у нормалізації метаболічних процесів, сприяє активації вуглеводного та ліпідного обмінів. а також бере участь в утворенні холіну, метіоніну, нуклеїнових кислот, процесах еритропоезу, покращує травлення [7,11].…”