Zahit BOLAMAN, Nil ÇULHACI, Bilal ACAR, İrfan YAVAŞOĞLU, Gürhan KADIKÖYLÜ

A probable cause of severe hepatotoxicity: Cytosine arabinoside

Malign hematolojik hastalıklarda karaciğer enzim yüksekliğinin ayırıcı tanısı zordur. Hematolojik malignitelerde akut hepatiti taklit eden ilaç iliskili hepatotoksitite gözlenebilir. Akut miyeloid lösemi (AML) tedavisinde sitozin arabinosid (Ara-C) kullanımına bağlı ciddi hepatotoksisite gözlenebilir. AML tedavisinde çok sayıda hasta Ara-C kullanımı sırasında baska ilaçlar kullanmakta ve kan transfüzyonu almaktadır. Bizim hastamızdaki hepatik hasar ilk kombinasyon tedavisinde Ara-C, sefepim, amikasin, meropenem, teikoplanin ve amfoterisin B gibi ilaçların kullanımı ile iliskili olabilir. Ancak ikinci konsolidasyon tedavisinde Ara-C’nin yanında herhangi bir antibiyotik ya da antifungal kullanılmadı. Karaciğer enzimlerindeki yükselme ilk kombinasyon tedavisinde konsolidasyon tedavisine göre daha fazlaydı. Bu nedenle lösemik hastalardaki ciddi hepatik disfonksiyonun ayırıcı tanısında Ara-C iliskili hepatotoksisite de göz önünde bulundurulmalıdır.

Ciddi hepatotoksisitenin olası bir nedeni: Sitozin arabinosid

Elevation in hepatic enzymes during the course of malignant hematological diseases may cause diagnostic difficulty. Here we present a patient who developed severe hepatotoxicity due to cytosine arabinoside (Ara-C) for treatment of acute myeloid leukemia. In the majority of patients, several drugs were used together with Ara-C during the course of treatment and blood transfusions were given. Therefore, it was difficult to differentiate which caused the hepatotoxicity. In our patient, hepatic damage might be related to Ara-C and other drugs such as sefepim, amikacin, meropenem, teicoplanin, and amphotericin B used in the first combination treatment. In conclusion, serious hepatotoxicity mimicking acute hepatitis may develop due to Ara-C for treatment of acute leukemia. However, in the second consolidation treatment, Ara-C was the only drug used and there were no other antibiotic or antifungal drugs. The elevation in hepatic enzymes was higher in the first combination treatment than in the second consolidation treatment with Ara-C. Therefore, hepatotoxicity due to Ara-C should also be considered in the differential diagnosis in leukemic patients with severe hepatic dysfunction

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