A case report: delayed high fever and maculopapules during Sorafenib treatment of ectopic hepatocellular carcinoma

Abstract

BackgroundSorafenib is the standard first-line therapy for hepatocellular carcinoma (HCC) and probably ectopic hepatocellular carcinoma (EHCC) as well. No report involves a side effect of delayed high fever of sorafenib. This manuscript describes a case of EHCC in the thoracic and abdominal cavities, who showed a delayed high fever and maculopapules during sorafenib treatment.Case presentationThe patient is a 63-year-old Chinese male with advanced EHCC, taking sorafenib 400 mg twice daily. On the tenth day, red maculopapules appeared all over the body. On the same day, the patient began to suffer from continuous high fever. Due to these effects, the patient was asked to cease sorafenib treatment, and the high fever and maculopapules were alleviated quickly. However, the symptoms were present again upon re-challenge of sorafenib. Prednisone was then administered to control the symptoms, with the dosage gradually reduced from 30 to 5 mg/day in 1.5 months. No recurrence of fever or maculopapules has been found. Tumor response reached partial response (PR) and progression free survival (PFS) reached 392 days + by the date of Apr. 14th, 2016.ConclusionEHCC could be treated like orthotopic HCC by oral administration of sorafenib, which shows good tumor response and survival benefit. Delayed high fever and maculopapules are potential, rare and severe side effects of sorafenib, and could be effectively controlled by glucocorticoid.

Challenge in Diagnosis and Treatment of Ectopic Hepatocellular Carcinoma: A Case Report and Literature Review

“…Although no lesion was found in the mother liver at the time of initial treatment, TACE was an option to prevent recurrence. Metastatic EHCC was reported on 5 patients ( 7 , 8 , 10 , 13 , 14 ). Only one of them showed no sign of recurrence after treatment ( 14 ).…”

A large ectopic hepatocellular carcinoma with adrenal infiltration: a rare case report

“…Of the 29 patients including this case, 26 patients underwent surgery treatment ( 1 , 3 – 8 , 10 – 15 , 17 , 18 , 20 – 29 ) and two patients did not undergo surgery due to serious complications ( 9 , 19 ). Traditional laparotomy and laparoscopy can be performed as the surgical methods, and seven patients received adjuvant therapy after surgery ( 5 , 11 , 15 , 24 , 25 , 27 ). For unresectable hepatocellular carcinoma, lenvatinib or sorafenib can be used as targeted drugs for adjuvant therapy in EHCC ( 30 ).…”

Ectopic hepatocellular carcinoma of the right adrenal gland: a case description

“…In 2 cases of adjuvant chemotherapy based on cisplatin and bleomycin, neither showed local recurrence or distal metastasis 8 months after surgery ( 1 , 15 ). Targeted therapy with sorafenib and recurrence-free survival of more than 1 year have also been reported ( 7 ). In some cases of EHCC, no postoperative adjuvant therapy was administered ( 9 , 10 ).…”

“…In approximately 7–30% of cases, ELT undergoes malignant transformation to EHCC ( 6 ). The most common organ in which ELT develops is the gallbladder, followed by the thoracic cavity, perihepatic sclerenchyma, pancreas, retroperitoneum, spleen, and adrenal gland ( 5 , 7 ).…”