Peg- Asparaginase induced hepatic injury-A concern for hepatologist

Abstract

Background and Aim: Peg-L Asparaginase is an important chemotherapeutic agent prescribed in Acute Lymphoblastic Leukaemia (ALL). L Asparaginase is a recognised cause of liver toxicity and patient presenting with deranged liver function should be investigated for this cause apart from primary liver infiltration. Case summary: We report a case of 48-year-old male known case of DM, diagnosed with Early T Cell Precursor (ETP) ALL, treated with BFM 2002 protocol with Daunorubicin, Vincristine, L asparaginase and Methotrexate. He presented with right upper quaant pain with anorexia and jaundice in 4th week of induction. On investigation his peak bilirubin reached uptil 14 mg/dl of which 11 mg/dl was direct component. The peak INR reached till 1.45 and SGOT and SGPT reached upto 350 IU/L and 380 IU/L respectively. Imaging was done suggestive of hepatomegaly with fatty liver infiltration. Rest all other liver specific tests were negative. He was started on symptomatic treatment and with UDCA. The drug was stopped and he improved symptomatically. Conclusions: L asparaginase can cause liver toxicity which may be improved after drug stoppage.