Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report
Abstract Background Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal a...
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Japan Surgical Society
2023-02-01
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| Series: | Surgical Case Reports |
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| Online Access: | https://doi.org/10.1186/s40792-023-01601-2 |
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| author | Shintaro Arakaki Shinichiro Ono Futoshi Kawamata Shinichiro Ishino Yasunori Uesato Tomo Nakajima Yukiko Nishi Satoko Morishima Shingo Arakaki Tatsuji Maeshiro Masayoshi Souri Akitada Ichinose Hiroaki Masuzaki Mitsuhisa Takatsuki |
| author_facet | Shintaro Arakaki Shinichiro Ono Futoshi Kawamata Shinichiro Ishino Yasunori Uesato Tomo Nakajima Yukiko Nishi Satoko Morishima Shingo Arakaki Tatsuji Maeshiro Masayoshi Souri Akitada Ichinose Hiroaki Masuzaki Mitsuhisa Takatsuki |
| author_sort | Shintaro Arakaki |
| collection | DOAJ |
| description | Abstract Background Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. Case presentation A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D). Conclusion Severe acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC. |
| format | Article |
| id | doaj-art-15bee75133d643bd9495cb516423607e |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2023-02-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-15bee75133d643bd9495cb516423607e2025-08-20T03:15:16ZengJapan Surgical SocietySurgical Case Reports2198-77932023-02-01911710.1186/s40792-023-01601-2Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case reportShintaro Arakaki0Shinichiro Ono1Futoshi Kawamata2Shinichiro Ishino3Yasunori Uesato4Tomo Nakajima5Yukiko Nishi6Satoko Morishima7Shingo Arakaki8Tatsuji Maeshiro9Masayoshi Souri10Akitada Ichinose11Hiroaki Masuzaki12Mitsuhisa Takatsuki13Department of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusDepartment of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusDepartment of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusDepartment of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusDepartment of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusDivision of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the RyukyusDivision of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the RyukyusDivision of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the RyukyusDepartment of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the RyukyusDepartment of Infectious, Respiratory, and Digestive Medicine, Graduate School of Medicine, University of the RyukyusThe Japanese Collaborative Research Group (JCRG) on Autoimmune Coagulation Factor Deficiency (AiCFD), Japanese Ministry of Health, Labor, and Welfare (MHLW)The Japanese Collaborative Research Group (JCRG) on Autoimmune Coagulation Factor Deficiency (AiCFD), Japanese Ministry of Health, Labor, and Welfare (MHLW)Division of Endocrinology, Diabetes and Metabolism, Hematology, Rheumatology, Graduate School of Medicine, University of the RyukyusDepartment of Digestive and General Surgery, Graduate School of Medicine, University of the RyukyusAbstract Background Atezolizumab plus bevacizumab therapy was recently introduced as the first line for unresectable advanced hepatocellular carcinoma (HCC), but immune-related adverse events (IrAEs) due to atezolizumab are a great concern. Here, we report the case of a patient who developed fatal acquired coagulation factor deficiency after hepatectomy for HCC, treated with atezolizumab and bevacizumab before surgery. Case presentation A 70-year-old man received right trisegmentectomy of the liver with hepaticojejunostomy for advanced HCC with bile duct invasion, after atezolizumab and bevacizumab therapy. The patient suffered the sudden onset of severe multiple coagulation factor deficiency (II, V, VII, VIII, IX, X, XI and XII) immediately following reoperation for anastomotic leakage of hepaticojejunostomy, 7 days after hepatectomy. The coagulation factor deficiency did not reverse even with intensive treatment, and the patient died of uncontrollable bleeding 32 days after hepatectomy. An IrAE due to atezolizumab was suspected because the patient had developed the possible IrAE of enthesitis of the right gastrocnemius muscle before surgery, and specific inhibitors against factor V and anti-factor V autoantibodies were detected, leading to an ultimate diagnosis of autoimmune FV/5 deficiency (AiF5D). Conclusion Severe acquired coagulopathy should be recognized as a possible life-threatening IrAE when using atezolizumab and bevacizumab for HCC.https://doi.org/10.1186/s40792-023-01601-2Acquired coagulation factor deficiencyHepatectomyImmune checkpoint inhibitor-related adverse event |
| spellingShingle | Shintaro Arakaki Shinichiro Ono Futoshi Kawamata Shinichiro Ishino Yasunori Uesato Tomo Nakajima Yukiko Nishi Satoko Morishima Shingo Arakaki Tatsuji Maeshiro Masayoshi Souri Akitada Ichinose Hiroaki Masuzaki Mitsuhisa Takatsuki Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report Surgical Case Reports Acquired coagulation factor deficiency Hepatectomy Immune checkpoint inhibitor-related adverse event |
| title | Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report |
| title_full | Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report |
| title_fullStr | Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report |
| title_full_unstemmed | Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report |
| title_short | Fatal acquired coagulation factor V deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor-related adverse event: a case report |
| title_sort | fatal acquired coagulation factor v deficiency after hepatectomy for advanced hepatocellular carcinoma as a possible immune checkpoint inhibitor related adverse event a case report |
| topic | Acquired coagulation factor deficiency Hepatectomy Immune checkpoint inhibitor-related adverse event |
| url | https://doi.org/10.1186/s40792-023-01601-2 |
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