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Life-threatening acute acalculous cholecystitis in a patient with renal cell carcinoma treated by sunitinib: a case report
© Nakano et al; licensee BioMed Central Ltd. 2012
Received: 27 September 2011
Accepted: 20 February 2012
Published: 20 February 2012
Sunitinib, an oral multitargeted tyrosine kinase inhibitor, is widely used in the treatment of renal cell carcinoma and gastrointestinal stromal tumor and has had a variety of adverse events. However, sunitinib-related acute cholecystitis has been reported in only two patients with gastrointestinal stromal tumor and renal cell carcinoma (clear cell subtype).
A 75-year-old Japanese woman with a right sided abdominal swelling was referred to our hospital. Computed tomography (CT) showed a hypervascular bulky tumor in her right kidney, suggesting right renal cell carcinoma in clinical T4N0M0. Although sunitinib therapy was started as neoadjuvant chemotherapy, during the fourth week of the first cycle, she developed acute acalculous cholecystitis and disseminated intravascular coagulation associated with sunitinib. Sunitinib therapy was discontinued immediately and she recovered after subsequent treatment with antibiotics and gabexate mesilate followed by percutaneous cholecystostomy. Cholecystectomy and right radical nephrectomy were performed and pathological examination showed that her renal tumor was a chromophobe renal cell carcinoma (pT2) with necrosis. Inflammation and ischemia were observed in the gallbladder wall, which was compatible with acute acalculous cholecystitis. There has been no evidence of disease recurrence for more than six months.
We described the third case of sunitinib-related acute cholecystitis in a patient with chromophobe renal cell carcinoma. Attention is required to sunitinib-related acute cholecystitis which, while uncommon, could be life-threatening.
Sunitinib, an oral multitargeted tyrosine kinase inhibitor, is widely used in the treatment of metastatic renal cell carcinoma (RCC) and gastrointestinal stromal tumor (GIST) and has been administered in the perioperative period . Although sunitinib has had a variety of adverse events, sunitinib-related acute cholecystitis has been reported in only two patients with GIST and RCC (clear cell subtype). We report a third case of sunitinib-related acute cholecystitis in a patient with chromophobe RCC who developed a serious condition.
Adverse drug reaction probability scale (Naranjo Scale) in the present case
1. Are there previous conclusive reports on this reaction?
2. Did the adverse event appear after the suspected drug was given?
3. Did the adverse reaction improve when the drug was discontinued or a specific antagonist was given?
4. Did the adverse reaction appear when the drug was readministered?
5. Are there alternative causes that could have caused the reaction?
6. Did the reaction reappear when a placebo was given?
7. Was the drug detected in any body fluid in toxic concentrations?
8. Was the reaction more severe when the dose was increased, or less severe when the dose was decreased?
9. Did the patient have a similar reaction to the same or similar drugs in any previous exposure?
10. Was the adverse event confirmed by any objective evidence?
A common clinical feature of sunitinib-related acute cholecystitis in three cases including our patient and the previous two cases [2, 3] was acalculous cholecystitis while gallbladder stones have been found in 90% of patients with acute cholecystitis . On the other hand, sunitinib causes vascular adverse events by vascular endothelial dysfunction [6, 7] resulting in myocardial ischemia  and proteinuria due to renal thrombotic microangiopathy . Likewise, sunitinib-related acute cholecystitis might be caused by the antivascular effect of sunitinib rather than gallbladder stones although the detailed mechanism underlying this adverse event is unclear. As sunitinib is widely used in the treatment of RCC and GIST, we need to pay attention to sunitinib-related acute cholecystitis which, while uncommon, could be life-threatening.
We described the third case of sunitinib-related acute cholecystitis in a patient with chromophobe RCC. Attention needs to be given to sunitinib-related acute cholecystitis which could be life-threatening albeit uncommon.
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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