2344 A Case of TACE: A Rare Complication of Transarterial Chemoembolization

Abstract

INTRODUCTION: Transarterial chemoembolization (TACE) represents a proven therapy providing survival advantage in patients with large, unresectable hepatocellular carcinoma (HCC) not amenable to transplant or ablative therapies. Here we discuss a case of post-TACE liver abscess, a rare complication of this procedure. CASE DESCRIPTION/METHODS: A 65-year-old male with 10-year history of alcoholic cirrhosis (MELD-Na 12) presented for follow-up after a recent TACE procedure. Despite initial HCC isolation to segment 3, the patient had refused surgical intervention at the time of initial diagnosis. The mass rapidly enlarged, with new satellite lesions in segments 5 and 6. TACE of the left gastric artery supplying the HCC was performed 7 months after initial diagnosis, with subsequent ultrasound-guided HCC microwave ablation of a 7 cm segment 3 mass. One month after TACE, the patient presented to the emergency department with 2 weeks of weakness, fevers, and an episode of dizziness leading to a fall. Admission studies were notable for marked leukocytosis and blood cultures yielding Streptococcus lutetiensis. The patient was started on broad-spectrum antibiotics and scheduled for further imaging for evaluation of bacteremia source. CT abdomen revealed multifocal hepatic abscesses and a large 7 cm abscess communicating with distal stomach/proximal duodenum. On day 6 of hospitalization, IR placed a CT-guided hepatic abscess drain. Abscess culture was positive for E.coli and Enterococcus, and blood cultures from day after the procedure grew out extended spectrum beta-lactamase E.coli. He was started on a 3-week course of Ertapenem and discharged home with JP drain in place for follow-up in 3 weeks. JP drain was removed 10 days after discharge, and follow-up CT showed a significant decrease in the left hepatic lobe abscess with a small residual collection several centimeters above the drain. Ertapenem was discontinued after total of 5 weeks of antibiotic therapy. DISCUSSION: Liver abscess is an uncommon complication of TACE, occurring in about 2% of cases. Here our patient received the recommended therapy of percutaneous abscess drainage and parenteral antibiotics, resulting in a resolution of symptoms. Recognition of this complication is critical, as post-TACE liver abscess mortality has been estimated to be as high as 13.3%. Recent studies have even suggested prophylactic antibiotics when performing chemoembolization, with results showing promise, though this is not currently a routine or recommended practice.