Medical School, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA.
BMJ Case Rep. 2024 Nov 14;17(11):e260830. doi: 10.1136/bcr-2024-260830.
Temozolomide (TMZ)-levetiracetam (LEV) combination therapy in glioblastoma management is gradually becoming a mainstay treatment given its superior effect compared with TMZ monotherapy. While there have been previous cases of hepatotoxicity, there are no prior reports of vanishing bile duct syndrome (VBDS) associated with TMZ-LEV combination use. This case report details a male in his 50s who had recently completed TMZ and LEV for right frontal lobe glioblastoma. He presented 3 days later with painless jaundice, dark urine and pale stools. Laboratory evaluation was remarkable for marked hyperbilirubinemia and transaminitis. Extensive work up for hepatic and extra-hepatic causes of jaundice was of no yield, thus necessitating a liver biopsy. Liver pathology showed a non-specific histomorphology pattern suggesting drug-induced liver injury and cholestasis with severe ductopenia. VBDS due to TMZ and LEV was diagnosed. The patient followed with the gastroenterology clinic over 6 months for persistently elevated liver function tests before suffering a fatal cardiac arrest.
替莫唑胺（TMZ）-左乙拉西坦（LEV）联合治疗在胶质母细胞瘤的治疗中逐渐成为一种主要的治疗方法，因为与 TMZ 单药治疗相比，它具有更好的效果。虽然以前有过肝毒性的病例，但没有 TMZ-LEV 联合使用相关的胆肠消失综合征（VBDS）的报告。本病例报告详细介绍了一名 50 多岁的男性，他最近完成了右额叶胶质母细胞瘤的 TMZ 和 LEV 治疗。他在 3 天后出现无痛性黄疸、深色尿液和浅色粪便。实验室评估显示明显的高胆红素血症和转氨基酶升高。广泛的肝内和肝外黄疸原因检查均无结果，因此需要进行肝活检。肝脏病理学显示非特异性组织形态学模式，提示药物性肝损伤和胆汁淤积伴严重胆管减少。诊断为 TMZ 和 LEV 引起的 VBDS。该患者在经历致命性心脏骤停之前，在 6 个月的时间里一直在消化科诊所就诊，因为肝功能持续升高。
