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Abstract
A 64-year-old man was treated with sunitinib as a first-line therapy for metastatic renal cell carcinoma. He was given oral sunitinib in cycles of 50 mg once daily for 2 weeks followed by a week off. During the 5th week of treatment right upper quadrant pain developed, but this resolved spontaneously during the 6th week (off treatment). However, on the 8th week of treatment, he was admitted to hospital because the acute right upper quadrant pain recurred with nausea, vomiting, and fever. Acute acalculous cholecystitis was then diagnosed by ultrasonography and CT. In addition, his laboratory findings indicated disseminated intravascular coagulation. Accordingly, sunitinib therapy was discontinued and broad-spectrum antibiotics initiated. He subsequently recovered after emergent percutaneous cholecystostomy. His Naranjo Adverse Drug Reaction Probability Scale score was 7, indicaing a probable association of the event with sunitinib. Suspicion of sunitinib-related acute cholecystitis is required, because, although uncommon, it can be life-threatening.
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Fig. 1.
Abdominal US. (A) US obtained before taking sunitinib showing a normal GB without stones. (B) US obtained after taking sunitinib for 8 weeks showing mild GB wall thickening (red arrowheads), GB hydrops (10×5 cm), sludges, and a small amount of ascites. US, ultrasonography; GB, gallbladder.
Fig. 2.
(A) Abdominal CT image obtained before initiating sunitinib therapy showing a normal GB without stones and a 3×3.4 cm sized renal mass (black arrow) on the left kidney. (B, C) CT image obtained after taking sunitinib for 8 weeks showing mild GB wall thickening, subserosal edema (red arrows), hydrops (11×5 cm), a GB wall defect (white arrow), and pericholecystic inflammatory stranding (red arrowheads). (D) Contrast medium depicted bile leakage during percutaneous transhepatic gallbladder drainage (blue arrow). CT, computed tomography; GB, gallbladder.
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