Vismodegib

Abstract

Hepatotoxicity and haemobilia: case reportA 62-year-old woman developed hepatotoxicity and haemobilia during treatment with vismodegib for basal cell carcinoma (BCC). The woman, who was diagnosed with stage 2 BCC, presented with profound jaundice and scleral icterus. The symptoms began 2 weeks after the completion of oral vismodegib [dosage not stated] for BCC of the left lateral forehead. Her medical history included pyrosis and hypertension. Laboratory investigations on admission were as follows: haemoglobin 12, ALT 287, AST 37, ALP 522, direct bilirubin 6.9, indirect bilirubin 4.3 and total bilirubin 11.2 [units not stated]. Liver biopsy showed findings suggestive of vismodegib-related injury characterised by bile ductular reaction and portal inflammation.The woman was stabilised and discharged home with scheduled outpatient monitoring weekly. However, 2 weeks later, she presented with melanotic stools and right upper quadrant pain for two days. On admission, her haemoglobin was 8.4 and underwent appropriate transfusions. An upper oesophagogastroduodenoscopy showed papillary orifice bleeding, suggesting haemobilia. She underwent coil embolisation and selective angiography to attain successful haemostasis. Her jaundice resolved completely in four weeks. Afterwards during 2 months follow-up, her liver function tests and haemoglobin normalised.