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- W2912426929 abstract "Introduction: Sorafenib is a multi tyrosine kinase inhibitor used for metastatic thyroid cancer. Acute hepatitis is a rare complication of this drug and is not well reported. We report a novel therapy to treat hepatotoxicity secondary to Sorafenib using N-Acetyl-cysteine (NAC). Case: A 63 year old female was admitted to the hospital for pain abdomen and vomiting of 1 week duration. She had a history of metastatic iodine-resistant thyroid cancer complicated by tracheostomy and PEG tube placement, hypertension and atrial fibrillation. Pateint was started on Sorafenib 4 weeks prior to admission. Other medications included Digoxin, Atorvastatin, Aspirin, Levothyroxine, and Metoprolol. She did not have have a history of alcohol consumption or use of herbal products. Examination revealed tachycardia, scleral icterus, and right upper quadrant abdominal tenderness. Laboratory panel revealed AST 391U/L, ALT 453U/L, Alkaline phosphatase 350U/L,Total Bilirubin 1.4mg/dL and INR 1.6. Biochemical panel 2 weeks prior admission were normal. Urine drug screen, serum alcohol and serum Acetaminophen levels were negative. Hepatitis serology and autoimmune panel were negative. CT abdomen and ultrasound revealed no hepatic or biliary pathology. Atorvastatin was stopped and the patient was started on NAC with the extended 21 hour IV regimen. LFTs peaked on day 3 with a maximum value of AST 3398 and ALT 2298. 3 days after initiating NAC her liver enzymes started trending downwards and by day 7 she had normal LFTs. Discussion: Only 4 other cases of severe acute Sorafenib-induced hepatitis has been described. Two of these patients already had underlying liver dysfunction. The case described above is consistent with the pattern of liver enzyme abnormalities seen in other cases of delayed drug-induced liver injury. Idiosyncratic reaction usually take 2-8 weeks to present and can manifest despite cessation of the drug. This is characterized by a rise in ALT 3 times the normal upper limit (ULN) and ratio of ALT/ULN:ALK/ULN>5. Routine use of NAC is not encouraged, but may be the only option in patients who are not candidates for liver transplant. This case has important implications in alerting clinicians to this rare and fatal drug reaction caused by Sorafenib, and a potential treatment option by the use of N- Acetylcysteine." @default.
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- W2912426929 date "2017-10-01" @default.
- W2912426929 modified "2023-09-25" @default.
- W2912426929 title "The Successful Use of N-Acetyl-cysteine to Treat Sorafenib-Induced Hepatotoxicity" @default.
- W2912426929 doi "https://doi.org/10.14309/00000434-201710001-02262" @default.
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