Portal hypertension after prolonged use of trastuzumab emtansine: nodular regenerative hyperplasia with autoimmune features

• Autor(a) principal: Monteiro, Gustavo Vargas Borgongino
• Data de Publicação: 2021
• Outros Autores: Mussi, Marcela Chagas Lima, Nardelli, Mateus Jorge, Santos, Bruno Campos, Couto, Cláudia Alves
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Research, Society and Development
• Texto Completo: https://rsdjournal.org/index.php/rsd/article/view/17005
• topic: Neoplasias da Mama; Trastuzumab; Hipertensão Portal; Hepatite autoimune.; Neoplasias de la Mama; Trastuzumab; Hipertensión Portal; Hepatitis autoinmune.; Breast Neoplasms; Trastuzumab; Hypertension, Portal; Hepatitis, autoimmune.

We report a rare complication associated with prolonged use of trastuzumab emtansine (T-DM1) – a composed therapy for HER2+ breast cancer – presenting with laboratorial autoimmune features that could have delayed the diagnosis or led to misdiagnosis. A 55-year-old female was referred to the hepatologist with a computed tomography suggestive of portal hypertension for etiological investigation. History of invasive ductal carcinoma in the right breast undergoing treatment for 5 years. She had already undergone neoadjuvant chemotherapy, mastectomy, radiotherapy and adjuvant chemotherapy. By the time of metastatic diagnosis, she was in monotherapy with T-DM1 for 2.5 years. Upper endoscopy showed esophageal varices and portal hypertension gastropathy. Laboratorial tests revealed increased transaminases, hypergammaglobulinemia and positive antinuclear antibody. Liver biopsy was performed for autoimmune hepatitis differential diagnosis but revealed nodular regenerative hyperplasia. T-DM1 was discontinued. After a 2-year follow-up, the patient did not present any complications of portal hypertension, although persisted with esophageal varices.