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• W3208531881 abstract "Introduction: Cytarabine is one of the chemotherapy agents used to treat acute myelogenous leukemia (AML). Cytarabine-based chemotherapy regimens are known to cause hepatic dysfunction. However, isolated hyperbilirubinemia is rarely reported. We describe a rare case of isolated hyperbilirubinemia in a patient treated with cytarabine-based chemotherapy for AML. Case Description/Methods: 62-year-old male with a history of hepatitis C infection presented to the hospital with few days of dyspnea and eventually diagnosed with AML. All baseline laboratory results were normal, except the full blood evaluation that was consistent with AML. He was started on intensive induction chemotherapy for AML with cytarabine (200 mg/m2) and idarubicin. Initially, he tolerated the chemotherapy well except for pancytopenia that required supportive blood product transfusions. On day 11 of induction, he started to develop jaundice and fatigue. Lab workup showed isolated direct hyperbilirubinemia with total bilirubin (TB) of 3.2 mg/dL and direct bilirubin (DB) of 1.6 mg/dL. This isolated hyperbilirubinemia remained during the admission course, peaking 14 days after admission at 22.6 and 10.2 mg/dL, respectively. Liver function tests (including transaminases and alkaline phosphatase) remained unremarkable. Other labs including ANA, anti-smooth muscle antibody, mitochondrial antibody, hepatitis A and B, IgA transglutaminase antibodies, IgA/IgG Gliadin antibodies, ceruloplasmin, immunoglobulins, IgM cytomegalovirus, IgM EBV VCA, and alpha-1 anti-trypsin were negative. Only anti-HCV antibodies were reactive, but hepatitis C RNA-PCR was negative. Magnetic resonance cholangiopancreatography imagining showed no biliary abnormalities. The patient’s clinical condition continued to deteriorate and required multiple blood products transfusion due to pancytopenia. On day 19 of induction, he elected to go home to hospice with no chemotherapy plans, and he died two days later. Discussion: Isolated hyperbilirubinemia is a rare presentation of cytarabine-induced liver dysfunction. The mechanism is not clear yet, but cytarabine may have cytotoxic effects on the gallbladder mucosa, leading to bile leakage and isolated hyperbilirubinemia. The usual course is benign with resolution after a long period. However, oncologists should be aware of such atypical complications of cytarabine. If needed, a lower dose of cytarabine for future treatment may be considered in those patients." @default.
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• W3208531881 date "2021-10-01" @default.
• W3208531881 modified "2023-09-27" @default.
• W3208531881 title "S3650 Isolated Direct Hyperbilirubinemia After Cytarabine for the Treatment of Acute Myelogenous Leukemia" @default.
• W3208531881 doi "https://doi.org/10.14309/01.ajg.0000788132.54713.62" @default.
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