Patient with hepatocellular carcinoma related to prior acute arsenic intoxication and occult HBV: epidemiological, clinical and therapeutic results after 14 years of follow-up

Abstract

Little is known about the long-term survivors of acute arsenic intoxication. We present here a clinical case report of a man with chronic hepatitis B virus (HBV) infection who developed hepatocellular carcinoma four years after acute arsenic poisoning. HBsAg was detected in serum in 1990 when he voluntarily donated blood. In 1991, the patient suffered from severe psychological depression that led him to attempt suicide by massive ingestion of an arsenic-containing rodenticide. He survived with polyneuropathy and paralysis of the lower limbs, and has been wheelchair-bound since then. During participation in a follow-up study conducted among HBV carriers, abdominal ultrasound detected a two-centimeter liver mass consistent with hepatocellular carcinoma. The tumor was confirmed by computed tomography (CT) and magnetic resonance image (MRI). Because of his significant comorbidity, the patient received palliative treatment with transarterial lipiodol chemoembolization (TACE) on three occasions (1996, 1997 and 1999). At his most recent visit in May 2005, the patient was asymptomatic, liver enzymes were normal and the tumor was in remission on ultrasound.

Figure 1

Non-contrast CT one month after arterial chemoembolization with iodized oil (Lipiodol) and doxorubicine emulsion. CT shows a 2-cm nodule with dense Lipiodol enhancement in segment VI (arrow), consistent with hepatocellular carcinoma.

Figure 2

Follow-up contrast-enhanced CT five years later from 1995 shows a small hypervascular lesion (arrow) in segment VI consistent with residual tumor. Tumoral Lipiodol retention was absent and the size of the lesion was significantly decreased.