Obstructive Jaundice Due to Duodenal Ulcer Induced by Lenvatinib Therapy for Hepatocellular Carcinoma

Abstract

An 82-year-old man with hepatocellular carcinoma presented with upper abdominal pain, vomiting, and jaundice. He had been taking a standard lenvatinib dose for three months. Although acute cholangitis was suggested, imaging studies failed to detect the biliary obstruction site. An endoscopic examination following discontinuation of lenvatinib and aspirin revealed multiple duodenal ulcers, one of which was formed on the ampulla of Vater and causing cholestasis. Endoscopic biliary drainage and antibiotics improved concomitant Enterobacter cloacae bacteremia. Ulcer healing was confirmed after rabeprazole was replaced with vonoprazan and misoprostol. Our case shows that lenvatinib can induce duodenal ulcers resulting in obstructive jaundice.

Helicobacter pylori Found Guilty of Obstructive Jaundice: A Pediatric Case Report

“…When exploring more recent literature, 2 separate reports describe adult male patients presenting with obstructive jaundice initially believed to be caused by malignancy until a final tissue diagnosis of ulcer was made (19,20). Additional reports include cases of obstructive jaundice caused by scar tissue associated with a non‐steroidal anti‐inflammatory drug‐induced ulcer, duodenal Crohn's disease, lenvatinib therapy, and off‐target radioembolization therapy (21–24). None of the aforementioned studies include pediatric patients and do not implicate H. pylori in the development of obstructive jaundice.…”