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Case Reports
. 2022 Sep 2;101(35):e30486.
doi: 10.1097/MD.0000000000030486.

Liver abscess in advanced hepatocellular carcinoma after atezolizumab plus bevacizumab treatment: A case report

Keisuke Uchida  1 , Yoshinori Ozono  1 , Naomi Uchiyama  1 , Hiroshi Hatada  1 , Kenichi Nakamura  1 , Yuri Komaki  1 , Hisayoshi Iwakiri  1 , Satoru Hasuike  1 , Kenji Nagata  1 , Yuichiro Sato  2 , Hiroshi Kawakami  1
Affiliations
Case Reports

Liver abscess in advanced hepatocellular carcinoma after atezolizumab plus bevacizumab treatment: A case report

Keisuke Uchida et al. Medicine (Baltimore). .

Abstract

Rationale: Hepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC.

Patient concerns: A 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital.

Diagnosis: Abdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess.

Interventions: Percutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed.

Outcomes: Despite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37.

Lessons: We report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.

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Conflict of interest statement

There are no funding or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
Abdominal computed tomography showing large hepatocellular carcinoma before atezolizumab plus bevacizumab treatment.
Figure 2.
Figure 2.
Abdominal computed tomography showing a gas-forming pyogenic liver abscess after atezolizumab plus bevacizumab treatment and (A) before and (B) after percutaneous liver abscess drainage.
Figure 3.
Figure 3.
Clinical course. CRP = C-reactive protein, MEPM = meropenem, MNZ = metronidazole, VCM = vancomycin, WBC = white blood cell.
Figure 4.
Figure 4.
Findings of postmortem examination. (A) The cut surface showed tumor with marked necrosis. Residual tumor (yellow area) was observed in the peripheral lesion. (B) Histologically, tumor showed marked necrotic (white arrows), with residual HCC (yellow arrows) at the margins and an abscess (black arrows) at the center of the tumor.
See this image and copyright information in PMC

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