仑伐替尼致鼻出血和腹部空腔脏器穿孔

Epistaxis and perforation of hollow organs of abdomen caused by lenvatinib

1例56岁男性晚期肝细胞肝癌患者接受仑伐替尼12 mg/d靶向治疗。用药30 d后患者出现晨起无诱因鼻出血,约半个月1次,压迫后可止血,未停药。用药97 d后,患者出现腹痛,查体全腹压痛,以中上腹明显,有反跳痛及肌紧张;全腹CT检查示腹腔积气、积液,空腔脏器穿孔。停用仑伐替尼,给予禁食、胃肠减压、抗感染、抑酸补液等保守治疗22 d后,患者腹痛缓解,恢复流质饮食;治疗26 d后患者排气、排便。此后,患者自行按原剂量再次服用仑伐替尼1周,再次发生鼻出血,再次停用仑伐替尼后未再出现鼻出血。考虑鼻出血和空腔脏器穿孔可能与仑伐替尼有关。

A 56‑year‑old male patient with advanced hepatocellular carcinoma received targeted therapy with lenvatinib 12 mg once daily.After 30 days of medication,the patient developed epistaxis without predisposing factors in the morning,which occurred once every half a month and could be stopped after compression.The drug was not stopped.After 97 days of medication,the patient developed abdominal pain.Physical examination showed abdominal tenderness,especially in the upper and middle abdomen,rebound pain,and muscle tension.Abdominal CT examination showed pneumoperitoneum,hydrops,and perforation of hollow organs of abdomen.Lenvatinib was withdrawn and the conservative treatments with fasting,gastrointestinal decompression,anti‑infection,acid suppression,and rehydration were given.After 22 days of treatments,his abdominal pain was relieved and the fluid diet was restored.After 26 days of treatments,the patient had exhaust and defecation.After that,the patient took lenvatinib with the same dose as before by himself again for one week,and epistaxis recurred.There was no epistaxis after discontinuation of lenvatinib again.It was considered that epistaxis and perforation of hollow organs might be related to lenvatinib.