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Zanubrutinib-induced liver injury: a case report and literature review

Atallah, Edmond; Wijayasiri, Pramudi; Cianci, Nicole; Abdullah, Khorrum; Mukherjee, Abhik; Aithal, Guruprasad P.

Zanubrutinib-induced liver injury: a case report and literature review Thumbnail


Authors

Edmond Atallah

Pramudi Wijayasiri

Nicole Cianci

Khorrum Abdullah



Abstract

Background: Zanubrutinib is a Bruton’s tyrosine kinase inhibitor that has been recently licensed in refractory mantle cell lymphoma and under assessment in phase 3 clinical trials for other B cell malignancies. To date, there are no reported cases of hepatotoxicity secondary to zanubrutinib. We report the first case of severe liver injury due to zanubrutinib.
Case presentation: A 56-year-old Caucasian male with a history of relapsed lymphoplasmacytic lymphoma was admitted to the hospital with new-onset jaundice, choluria, and pruritus for 10 days. He had been on zanubrutinib as part of a clinical trial for 30 months. His blood profile showed a severe hepatocellular injury with jaundice (alanine transaminase 2474 IU/L and total bilirubin 141 umol/L with mild coagulopathy). He had an extensive work-up including virology, autoimmune, and metabolic profiles in addition to abdominal ultrasound with no alternative explanation found for his liver injury. Zanubrutinib-induced liver injury was suspected, and causality assessment by the updated Roussel Uclaf Causality Assessment Method score showed a probable causal relationship with zanubrutinib. His liver histology was also consistent with drug-induced liver injury. His liver biochemistry improved following cessation of zanubrutinib and normalised after 8 weeks.
Conclusion: We report the first case of severe liver injury secondary to zanubrutinib after 30 months of treatment. This case raises clinical awareness regarding zanubrutinib-induced liver toxicity and the importance of drug withdrawal in the event of liver injury.

Citation

Atallah, E., Wijayasiri, P., Cianci, N., Abdullah, K., Mukherjee, A., & Aithal, G. P. (2021). Zanubrutinib-induced liver injury: a case report and literature review. BMC Gastroenterology, 21(1), Article 244. https://doi.org/10.1186/s12876-021-01825-2

Journal Article Type Article
Acceptance Date May 23, 2021
Online Publication Date May 29, 2021
Publication Date Dec 1, 2021
Deposit Date Jun 11, 2021
Publicly Available Date Jun 21, 2021
Journal BMC Gastroenterology
Electronic ISSN 1471-230X
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 21
Issue 1
Article Number 244
DOI https://doi.org/10.1186/s12876-021-01825-2
Keywords Gastroenterology; General Medicine
Public URL https://nottingham-repository.worktribe.com/output/5655249
Publisher URL https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-021-01825-2

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