Sidhu S S, Agarwal S, Goyal O, Kishore H, Sidhu S
Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Himalayan institute of Medical Sciences, Swami Rama Himalayan University, Doiwala, Dehradun, Uttarkhand, India.
Acta Gastroenterol Belg. 2017 Oct-Dec;80(4):537-538.
A 60 year old male, known case of Hepatitis C related cirrhosis was diagnosed with exophytic Hepatocellular carcinoma (size 2.1 x 2.2 cm), Barcelona Clinic Liver Cancer Stage A, on routine surveillance. He refused liver Transplant and underwent laparoscopic segmental resection. Thereafter patient was started on Tablet Sorafenib 400mg twice daily to prevent recurrence of Hepatocellular carcinoma. On 18st post-operative day, patient presented with Hepatic encephalopathy. Routine investigations and MRI Brain were normal; Venous ammonia was high. Sorafenib was discontinued, and neurological symptoms resolved within 24 hours. The ammonia level decreased from 112 to 30 μmol/L. Hepatic encephalopathy recurred 14 days after Sorafenib reintroduction at a dose of 400 mg / day. It resolved within 24 hours of withdrawal of Sorafenib. Sorafenib induced recurrent acute overt Hepatic encephalopathy with biochemical corroboration is reported here.
一名60岁男性，已知患有丙型肝炎相关性肝硬化，在常规监测中被诊断为外生性肝细胞癌（大小为2.1×2.2厘米），巴塞罗那临床肝癌分期为A期。他拒绝肝移植，接受了腹腔镜分段切除术。此后，患者开始每日两次服用400毫克索拉非尼片，以预防肝细胞癌复发。术后第18天，患者出现肝性脑病。常规检查和脑部MRI均正常；静脉血氨升高。停用索拉非尼后，神经症状在24小时内缓解。血氨水平从112降至30微摩尔/升。在以400毫克/天的剂量重新引入索拉非尼14天后，肝性脑病复发。停用索拉非尼后24小时内症状缓解。本文报道了索拉非尼诱导的复发性急性显性肝性脑病并伴有生化证据。
