We report a 74-year-old male patient with compensated cirrhosis after hepatic C virus eradication. After the patient underwent hepatectomy for hepatocellular carcinoma, multiple lung and lymph node metastases were detected by computed tomography. Computed tomography also revealed a portosystemic shunt from the superior mesenteric vein to the right testicular vein. He was administered lenvatinib (12 mg). Five days after the initiation of lenvatinib, he developed grade 3 hepatic encephalopathy, and his ammonia level increased. Lenvatinib was stopped, with improvement of the encephalopathy and decrease in ammonia level. When lenvatinib was restarted, grade 2 encephalopathy recurred which then improved upon stopping the drug. We thought that the encephalopathy was due to the portosystemic shunt, and occlusion of the shunt was performed. The day after shunt occlusion, lenvatinib (8 mg) was restarted, and the lenvatinib dose was increased to 12 mg at 2 days after shunt occlusion. Subsequently, the ammonia level remained stable and the patient remained alert and conscious. Lenvatinib was continued until the time of this report (40 days after shunt occlusion), and after 1 month of lenvatinib therapy, the computed tomography verified absence of the portosystemic shunt and stable disease of hepatocellular carcinoma.
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Compliance with ethical standards
Conflict of interest
Kazuaki Chayama has received honorarium from MSD, Bristol-Myers Squibb, AbbVie, Ajinomoto Pharma, Abbott, Astellas Pharma, Chugai, Dainippon Sumitomo Pharma, Gilead Sciences, Mitsubishi Tanabe. Kazuaki Chayama has received research funding from Janssen, Mitsubishi Tanabe, Dainippon Sumitomo, Toray. Kazuo Awai has research funding from Canon Medical Systems, Hitachi, Rrserch. Kazuaki Chayama has received educational grants from AbbVie, Dainippon Sumitomo, Ajinomoto Pharma, MSD, Eisai, Toray, Otsuka, Mitsubishi Tanabe, Chugai, Daiichi Sankyo, Takeda, Nippon Kayaku, Bristol-Myers Squibb, Roche.
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all patients for being included in the study.
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