120 Oxaliplatin induced liver injury in a patient with metastatic colorectal adenocarcinoma, a rare case report

Introduction/Objective Oxaliplatin is an alkylating agent used as a mainstay adjuvant chemotherapy for stage III colorectal cancer. Very few cases have been reported in the literature about Oxaliplatin induced liver injury. We report a rare case of Oxaliplatin induced liver injury in a patient with metastatic colorectal adenocarcinoma to the liver. Methods/Case Report A 59-year-old female presents to our hospital seeking consultation for a newly diagnosed metastatic colon cancer to the liver. The patient initially noticed changes in her bowel habits, which prompted her to have a colonoscopy. Colonoscopy noted intrinsic severe stenosis in the sigmoid colon. Biopsy of sigmoid colon mass revealed well differentiated adenocarcinoma. CT imaging demonstrated multiple new lesions, involving right and left lobes, with largest one measuring 3.3 cm in greatest dimension in liver segment 7. Tumor markers were elevated- CEA: 49.3, CA19-9: 14.4, and CA125: 10.4. Liver function tests (AST/ALT and alkaline phosphatase) were mildly elevated. She received 6 cycles of FOLFOX regimen and then underwent a hemicolectomy and partial hepatectomy. Histopathological examination of sigmoid colon revealed invasive adenocarcinoma with one metastatic lymph node (ypT4aN1aM1a). Among the three hepatic resection analyzed, besides the metastatic adenocarcinoma consistent with colon primary, the background liver in one of the hepatectomy showed areas of marked sinusoidal dilatation and congestion with peri-sinusoidal fibrosis consistent with Oxaliplatin effect. These were the areas that had appeared white tan, firm and markedly hemorrhagic on gross examination. In rest of the hepatic resections the background liver parenchyma was unremarkable. Results N/A Conclusion In our case report, we found a significant correlation between the use of Oxaliplatin and the development of severe sinusoidal liver injury. This case highlights the significant adverse effect of Oxaliplatin in liver and long term monitoring is warranted for patients on this chemotherapeutic agent.