Imatinib-induced Hepatitis in a Patient Treated for Gastrointestinal Stromal Tumor: A Rare Adverse Effect

Jamil M Shah,Madhavi Reddy,Denzil Etienne,Yingxian Liu,Kyawzaw Lin

doi:10.7759/cureus.2529

Abstract

Gastrointestinal stromal tumors (GISTs) are rare neoplasms of the digestive tract. The clinical behavior of GISTs varies greatly, has extended follow-up, and almost all of the tumors have malignant potential. The introduction of imatinib has led to extraordinary improvements in the treatment of individuals with GISTs (as well as those with Philadelphia chromosome-positive chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (ALL)). However, there have been notable postmarketing reports of adverse drug reactions of hepatotoxicity with the use of imatinib. By our search, among individuals taking imatinib for the treatment of GIST, only six cases of drug-induced liver injury (DILI) have been reported. Here, we present an interesting case of an elderly woman who developed DILI after taking imatinib for the treatment of GIST. As the liver function tests (LFTs) initially did not improve, it was decided to proceed with an interventional radiology (IR)-guided liver biopsy, which showed a histologic pattern of acute hepatitis, consistent with DILI. Ultimately, discontinuation of the antineoplastic agent led to recovery in the patient’s clinical condition along with normalization of her LFTs over the next several weeks. Thus, it is essential that physicians remain alert for and suspect DILI for any patient being treated with imatinib who presents with a sudden elevation of LFTs. The key to making the diagnosis is stopping the offending agent and closely monitoring the liver enzymes for improvement. When discontinuation of imatinib alone does not lead to improvement in LFTs and the patient’s clinical status, a detailed history should be taken and initial diagnostic testing performed to exclude other etiologies. And, if they are negative, a liver biopsy should be considered.

Highlights

Gastrointestinal stromal tumors (GISTs), the most common mesenchymal neoplasms of the digestive tract, are relatively rare primary GI cancers [1]
A 58-year-old Caucasian woman, with past medical history significant for a 2.4 cm GIST diagnosed with esophagogastroduodenoscopy (EGD) (Figures 1, 2) six months earlier and s/p laparoscopic partial gastrectomy, presented to the emergency department (ED) with new-onset jaundice initially observed by her son four days prior to arrival
Drugs can imitate all of the histologic patterns found in primary liver disease, including those of acute, chronic, vascular, or neoplastic disorders caused by other etiologies, making the task difficult even on biopsy

Summary

Introduction

Gastrointestinal stromal tumors (GISTs), the most common mesenchymal neoplasms of the digestive tract, are relatively rare primary GI cancers [1]. A 58-year-old Caucasian woman, with past medical history significant for a 2.4 cm GIST diagnosed with esophagogastroduodenoscopy (EGD) (Figures 1, 2) (performed for persistent epigastric pain despite therapy) six months earlier and s/p laparoscopic partial gastrectomy, presented to the emergency department (ED) with new-onset jaundice initially observed by her son four days prior to arrival. She reported generalized weakness, fatigue, and itching for the past several days.

Discussion

Conclusions

Disclosures

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