Ascites Presenting as a Peritonitis-Like Manifestation and Liver Injury due to Trabectedin Monotherapy in a Patient With Myxoid Liposarcoma.
Tatsuyuki Kawahara, Hiromichi Yamane, Ayaka Mimura et al.
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Case in brief
An 82-year-old woman with recurrent metastatic myxoid liposarcoma developed liver dysfunction and ascites while receiving trabectedin monotherapy, after 12 cycles. Laboratory testing showed Grade 3 hepatic dysfunction, and imaging confirmed ascitic fluid. With no evidence of infection or thrombosis, the findings were attributed to trabectedin-induced liver injury. Supportive care, including hepatoprotective therapy, was followed by clinical improvement and resolution of the ascites.
What made this case unusual
The liver injury was accompanied by ascites presenting with peritonitis-like features, an uncommon manifestation of trabectedin-associated hepatotoxicity.
Diagnostic / clinical pearl
In a patient receiving trabectedin who develops ascites with peritonitis-like symptoms, assess for hepatic dysfunction and exclude infection and thrombosis before attributing the presentation to drug-induced liver injury.
Why it matters
The case underscores the need for vigilance for liver injury and ascites during trabectedin therapy.