Prednisolone/tamoxifen

Abstract

Thrombocytopaenia, thrombosis and liver infarction: case report A 49-year-old woman developed thrombocytopenia and liver infarction during treatment with tamoxifen and hepatic artery thrombosis, portal vein thrombosis and deep vein thrombosis of leg during treatment with tamoxifen and prednisolone for encapsulating peritoneal sclerosis (EPS). The woman, who had end-stage renal disease (ESRD), was hospitalized with abdominal pain, which abruptly occurred during hemodialysis. She had been receiving oral tamoxifen 10mg and oral prednisolone 20mg for the conservative management of encapsulating peritoneal sclerosis (EPS) for 8 months. Abdominal CT scan showed EPS with massive amounts of ascites with numerous renal cysts. Abdominal X-ray showed mechanical ileus and ascites with calcification along the peritoneal membrane. Due to EPS, there was a feeling of touching dough. Her lab tests showed white blood cell of 6910 /μL, C-reactive protein of 9.3 mg/L, thrombocytopenia, antithrombin-III of 40%, fibrinogen of 198 mg/dL and D-dimer of 1176 ng/mL. CT angiography findings were consistent with liver infarction. A 3-dimensional reconstructed view of the vessels showed diffuse luminal narrowing of the left hepatic artery and branch of the left portal vein. Additionally, the left side of the liver was not visualized. She was diagnosed with both hepatic artery thrombosis and portal vein thrombosis, as well as liver infarction. The woman was treated with analgesics. She was discharge, and tamoxifen and prednisolone were maintained after the discharge. However, one month later, she was re-admitted with abdominal pain and left leg swelling. She suffered from frequent abdominal pain and was unable to take medication orally; therefore, all medications were discontinued. Doppler sonography showed extensive proximal deep vein thrombosis involving the right common femoral vein, saphenous vein, and popliteal vein. She also developed malnutrition due to poor oral intake. Thereafter, fever occurred, but as she refused to receive parenteral nutrition and antibacterials, she had an acute downhill course and finally died of Gram-negative sepsis.