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Microscopic Polyangiitis Complicated by the Development of Prostate Cancer and Flutamide-induced Hepatitis

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Abstract

We report a case of a 65-year-old man with microscopic polyangiitis who developed prostate cancer and gastric adenocarcinoma after prolonged oral use of cyclophosphamide. Acute hepatitis with jaundice and marked increase in aminotranferases occurred after 6 months of flutamide treatment for metastatic prostate carcinoma. It is suggested that patients with vasculitis or other autoimmune disorders should avoid prolonged use of cyclophosphamide and other cytotoxic drugs in order to minimize long-term adverse effects, of which the risk of cancer is by far the most important. In patients on flutamide treatment, careful monitoring of flutamide administration with repeated liver function tests should be undertaken, and the drug must be immediately discontinued in patients with abnormal results to avoid progression of liver injury.

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References

  1. F Lhote L Guillevin (1995) ArticleTitlePolyarteritis nodosa, microscopic polyangiitis, and Churg–Strauss syndrome clinical aspects and treatment Rheum Dis Clin North Am 21 9911–9947

    Google Scholar 

  2. L Guillevin B Durand-Gasselin R Cevallos et al. (1999) ArticleTitleMicroscopic polyangiitis. Clinical and laboratory findings in 85 patients Arthritis Rheum 42 421–430 Occurrence Handle10.1002/1529-0131(199904)42:3<421::AID-ANR5>3.0.CO;2-6 Occurrence Handle1:STN:280:DyaK1M7os1Khtg%3D%3D Occurrence Handle10088763

    Article  CAS  PubMed  Google Scholar 

  3. D Lauque J Cadranel R Lazor et al. (2000) ArticleTitleMicroscopic polyangiitis with alveolar hemorrhageA study of 29 cases and review of the literature Medicine (Baltimore) 79 222–233 Occurrence Handle10.1097/00005792-200007000-00003 Occurrence Handle1:STN:280:DC%2BD3cvhsVGgtQ%3D%3D

    Article  CAS  Google Scholar 

  4. COS Savage CG Winearls DJ Evans AJ Rees CM Lockwood (1985) ArticleTitleMicroscopic polyarteritis: presentation, pathology and prognosis Q J Med 56 467–483 Occurrence Handle1:STN:280:BimD3MjltFQ%3D Occurrence Handle4048389

    CAS  PubMed  Google Scholar 

  5. D Adu A Pall RA Luqmani et al. (1997) ArticleTitleControlled trial of pulse versus continuous prednisolone and cyclophosphamide in the treatment of systemic vasculitis Q J Med 90 401–409 Occurrence Handle1:STN:280:ByiA2cbnsFM%3D

    CAS  Google Scholar 

  6. L Guillevin P Cohen A Mahr et al. (2003) ArticleTitleTreatment of polyarteritis nodosa and microscopic polyangiitis with poor prognosis factors: a prospective trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in sixty-five patients Arthritis Care Res 49 93–100 Occurrence Handle10.1002/art.10922 Occurrence Handle1:CAS:528:DC%2BD3sXhslKmtrw%3D

    Article  CAS  Google Scholar 

  7. D Jayne (2001) ArticleTitleUpdate on the European Vasculitis Study Group trials Curr Opin Rheumatol 13 48–55 Occurrence Handle1:STN:280:DC%2BD3M7isFSksw%3D%3D Occurrence Handle11148715

    CAS  PubMed  Google Scholar 

  8. CA Langford (2001) ArticleTitleManagement of systemic vasculitis Best Pract Res Clin Rheumatol 15 281–297 Occurrence Handle10.1053/berh.2001.0144 Occurrence Handle1:CAS:528:DC%2BD38Xhs1Kktw%3D%3D Occurrence Handle11469822

    Article  CAS  PubMed  Google Scholar 

  9. GS Hoffman GS Kerr RY Leavitt et al. (1992) ArticleTitleWegener's grnulomatosis: an analysis of 158 patients Ann Intern Med 116 488–498 Occurrence Handle1:STN:280:By2C2M3lvFU%3D Occurrence Handle1739240

    CAS  PubMed  Google Scholar 

  10. Hoffman GS. Vasculitides B. Wegener's Granulomatosis, Churg–Strauss Vasculitis. In: Klippel JH, Crofford LJ, Stone JH, Weyand CM, eds. Primer on the Rheumatic Diseases. 12 edn. Atlanta: Arthritis Foundation, 2001: 392–396.

  11. CD Radis LE Kahl GL Baker et al. (1995) ArticleTitleEffects of cyclophosphamide on the development of malignancy and on long-term survival of patients with rheumatoid arthritis. A 20-year follow up study Arthritis Rheum 38 1120–1127 Occurrence Handle1:CAS:528:DyaK2MXns1WisLY%3D Occurrence Handle7639809

    CAS  PubMed  Google Scholar 

  12. A Knight J Askling A Ekbom (2002) ArticleTitleCancer incidence in a population-based cohort of patients with Wegener's granulomatosis Int J Cancer 100 82–85 Occurrence Handle10.1002/ijc.10444 Occurrence Handle1:CAS:528:DC%2BD38XksVGntbs%3D Occurrence Handle12115591

    Article  CAS  PubMed  Google Scholar 

  13. KW Westman PG Bygren H Olsson J Ranstam J Wieslander (1998) ArticleTitleRelapse rate, renal survival, and cancer morbidity in patients with Wegener's granulomatosis or microscopic polyangiitis with renal involvement J Am Soc Nephrol 9 842–852 Occurrence Handle1:STN:280:DyaK1c3lsFGhsw%3D%3D Occurrence Handle9596082

    CAS  PubMed  Google Scholar 

  14. PC Sogani MR Vagaiwaala WF Whitmore SuffixJr (1984) ArticleTitleExperience with flutamide in patients with advanced prostatic cancer without prior endocrine therapy Cancer 54 744–750 Occurrence Handle1:STN:280:BiuB2MfptVw%3D Occurrence Handle6378356

    CAS  PubMed  Google Scholar 

  15. R Lundgren (1987) ArticleTitleFlutamide as primary treatment for metastatic prostatic cancer Br J Urol 59 156–158 Occurrence Handle1:STN:280:BiiC2Mflt1M%3D Occurrence Handle3828712

    CAS  PubMed  Google Scholar 

  16. JL Gomez A Dupont L Cusan et al. (1992) ArticleTitleIncidence of liver toxicity associated with the use of flutamide in prostate cancer patients Am J Med 93 465–470

    Google Scholar 

  17. S Moller P Iversen MB Fransman (1990) ArticleTitleFlutamide-induced liver failure J Hepatol 10 346–349 Occurrence Handle10.1016/0168-8278(90)90144-G Occurrence Handle1:STN:280:By%2BA3cfisVA%3D Occurrence Handle2365984

    Article  CAS  PubMed  Google Scholar 

  18. DK Wysowski (1993) ArticleTitleFatal and non fatal hepatotoxicity associated with flutamide Ann Intern Med 118 860–864 Occurrence Handle1:STN:280:ByyB2czmtFU%3D Occurrence Handle7683180

    CAS  PubMed  Google Scholar 

  19. SP Dourakis AA Alexopoulou SJ Hadziyannis (1994) ArticleTitleFulminant hepatitis after flutamide treatment J Hepatol 20 350–353 Occurrence Handle10.1016/S0168-8278(94)80006-5 Occurrence Handle1:STN:280:ByuB1cvlslw%3D Occurrence Handle8014445

    Article  CAS  PubMed  Google Scholar 

  20. DK Wysowski JL Fourcroy (1996) ArticleTitleFlutamide hepatotoxicity J Urol 155 209–212 Occurrence Handle1:CAS:528:DyaK28XktlyntLg%3D Occurrence Handle7490837

    CAS  PubMed  Google Scholar 

  21. RL Crownover J Holland A Chen et al. (1996) ArticleTitleFlutamide-induced liver toxicity including fatal hepatic necrosis Int J Rad Oncol Biol Phys 34 911–915 Occurrence Handle10.1016/0360-3016(95)02107-8 Occurrence Handle1:CAS:528:DyaK28XisVCit74%3D

    Article  CAS  Google Scholar 

  22. C Cicognani M Malavolti AM Morselli-Labate C Sama L Barbara (1996) ArticleTitleFlutamide-induced toxic hepatitis. Potential utility of ursodeoxycholic acid administration in toxic hepatitis Dig Dis Sci 14 2219–2221

    Google Scholar 

  23. M Cetin D Demirci A Unal et al. (1999) ArticleTitleFrequency of flutamide induced hepatotoxicity in patients with prostate carcinoma Hum Exp Toxicol 18 137–140 Occurrence Handle1:CAS:528:DyaK1MXitFCitbo%3D Occurrence Handle10215102

    CAS  PubMed  Google Scholar 

  24. G Lazaros P Angelopoulou S Chryssou A Bourlis G Anagnostopoulos N Tassopoulos (2001) ArticleTitleFlutamide-induced hepatotoxicity Ann Gastroenterol 14 125–127

    Google Scholar 

  25. S Stefanidis D Dionysopoulos M Kotti E Gianoulis A Tourkantonis (2001) ArticleTitleFatal outcome of acute liver failure due to flutamide treatment Ann Gastroenterol 14 338–339

    Google Scholar 

  26. M Garcia Cortes RJ Andrade MI Lucena et al. (2001) ArticleTitleFlutamide-induced hepatotoxicity: report of a case series Rev Esp Enferm Dig 93 425–432

    Google Scholar 

  27. ED Crawford MA Eisenenberger DG McLeod et al. (1989) ArticleTitleA controlled trial of leuprolide with and without flutamide in prostatic carcinoma N Engl J Med 321 419–424 Occurrence Handle1:STN:280:BiaA2cvhtlE%3D Occurrence Handle2503724

    CAS  PubMed  Google Scholar 

  28. JL Gomez A Dupont L Cusan M Tremblay F Labrie (1992) ArticleTitleSimultaneous liver, lung toxicity related to the nonsteroidal antiandrogen nilutamide (Anandron): a case report Am J Med 92 563–566 Occurrence Handle1:STN:280:By2B2MvovFY%3D Occurrence Handle1580304

    CAS  PubMed  Google Scholar 

  29. L Dawson E Chow G Morton (1997) ArticleTitleFulminant hepatic failure associated with bicalutamide Urology 49 283–284 Occurrence Handle10.1016/S0090-4295(96)00355-X Occurrence Handle1:STN:280:ByiC1cbgt1M%3D Occurrence Handle9037299

    Article  CAS  PubMed  Google Scholar 

  30. S Sherlock (1986) ArticleTitleThe spectrum of hepatotoxicity due to drugs Lancet ii 440–444

    Google Scholar 

  31. RN Brodgen SP Clissold (1989) ArticleTitleFlutamide. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic efficacy in advanced prostatic cancer Drugs 38 185–203

    Google Scholar 

  32. D Fau D Eugene A Berson et al. (1994) ArticleTitleToxicity of the antiandrogen flutamide in isolated rat hepatocytes J Pharmacol Exp Ther 269 954–962 Occurrence Handle1:CAS:528:DyaK2cXksV2kt74%3D Occurrence Handle8014883

    CAS  PubMed  Google Scholar 

  33. L Pontiroli M Sartori S Pittau S Morelli R Boldorini E Albano (1998) ArticleTitleFlutamide-induced acute hepatitis investigation of the role of immunoallergic mechanisms Ital J Gastroenterol Hepatol 30 310–314 Occurrence Handle1:STN:280:DyaK1cvjtFOltQ%3D%3D Occurrence Handle9759603

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Arta General Hospital, Arta, Greece

    D. Papaioannides & P. Korantzopoulos

  2. Department of Urology, Arta General Hospital, Arta, Greece

    C. Bouropoulos

  3. University Department of Respiratory Medicine, ‘Sotiria’ Hospital for Chest Diseases, Athens, Greece

    P. Latsi & D. Orphanidou

  4. Department of Pathology, ‘Sotiria’ Hospital for Chest Diseases, Athens, Greece

    M. Fotinou

  5. D. Papaioannides, P.O. Box 63, 19004, Spata, Greece

    D. Papaioannides

Authors
  1. D. Papaioannides
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  2. P. Korantzopoulos
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  3. C. Bouropoulos
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  4. P. Latsi
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  5. M. Fotinou
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  6. D. Orphanidou
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Correspondence to D. Papaioannides.

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Papaioannides, D., Korantzopoulos, P., Bouropoulos, C. et al. Microscopic Polyangiitis Complicated by the Development of Prostate Cancer and Flutamide-induced Hepatitis. Int Urol Nephrol 37, 515–520 (2005). https://doi.org/10.1007/s11255-005-2093-0

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  • DOI: https://doi.org/10.1007/s11255-005-2093-0

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