Splenic infarction associated with sorafenib use in a hepatocellular carcinoma patient

Abstract

Sorafenib, a multitargeted tyrosine kinase inhibitor, has been shown to improve survival in patients with advanced hepatocellular carcinoma (HCC). As the clinical use of sorafenib increases, many adverse effects have been reported, such as hand-foot skin reaction, diarrhea, anorexia, asthenia, alopecia, weight loss, hypertension and arterial thromboembolism. However, there are no prior reports of splenic infarction as an adverse effect of sorafenib. Here, a case of splenic infarction in a patient with HCC who was treated with sorafenib is reported. The patient had no other predisposing factors to explain the splenic infarction except for the administration of sorafenib. The splenic infarction improved after sorafenib was discontinued; however, the HCC progressed.

Keywords: Adverse effects; Hepatocellular carcinoma; Sorafenib; Splenic infarction; Tyrosine kinase inhibitor.

Figure 1

Contrast-enhanced abdominal computed tomography. A wedge-shaped hypodense lesion in the spleen is consistent with splenic infarction (arrow). Hepatic artery catheter is seen in hepatic artery as artifact.

Figure 2

Follow up abdominal computed tomography (1 mo). New hypodense lesion has developed in upper level of the spleen (arrow).

Figure 3

Contrast-enhanced computed tomography scan in arterial phase at the time of diagnosis of initial splenic infarction (A) and 2 mo later (B). A: When splenic infarction was diagnosed, an approximately 4 cm x 4 cm sized hepatocellular carcinoma (HCC) (arrow) was shown in S6; B: Two months later, the size of HCC was enlarged to 5 cm × 5 cm (arrow) and an intrahepatic metastatic nodule was also seen (arrowhead) beside main mass.