The enigma of persistent hypertriglyceridemia: A case report.
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ABSTRACT:
SUBMITTER: Dhaliwal A
PROVIDER: S-EPMC8943104 | biostudies-literature | 2022 Mar
REPOSITORIES: biostudies-literature
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The enigma of persistent hypertriglyceridemia: A case report.
Dhaliwal Armaan A Ravi Soumiya S Bains Kanwal K Potharaju Anil Kumar AK Shah Tasneem T
Clinical case reports 20220323 3
A patient with a history of Mandibular hypoplasia, Deafness, Progeroid Features Associated Lipodystrophy Syndrome (MDPL), familial lipodystrophy presented with hypertriglyceridemia induced pancreatitis with triglycerides in the 3000s. This lipodystrophy occurs due to a mutation in the POLD1 gene (DNA polymerase delta 1). MDPL, hypertriglyceridemia, pancreatitis, POLD1. ...[more]
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Project description:We had previously reported on S-1-induced hypertriglyceridemia. Here, we report fluorouracil-induced hypertriglyceridemia in a patient with capecitabine-induced hypertriglyceridemia and the corresponding therapeutic process. A woman in her forties who had experienced grade 3 hypertriglyceridemia due to oxaliplatin + capecitabine was administered fluorouracil ± oxaliplatin + levofolinate calcium + panitumumab; however, grade 4 hypertriglyceridemia occurred after the thirteenth administration. Bezafibrate normalized the elevation. Chemotherapy cessation resulted in its decrease to normal, and bezafibrate was stopped. Nine months after cessation, treatment with fluorouracil + irinotecan + levofolinate calcium + ramucirumab was initiated. After four cycles of treatment, her serum triglyceride levels increased again to grade 3, and then, fenofibrate was administered, resulting in a significant decrease to grade 1-2. Serum triglyceride levels significantly reduced after cessation of the prior fluorouracil-containing regimen, although its elevation was observed again following the latter treatment. Therefore, fluorouracil-induced hypertriglyceridemia was strongly speculated in this case. We have speculated that the most probable cause of tegafur and capecitabine-induced hypertriglyceridemia is fluorouracil or its metabolic enzymes since their end product is fluorouracil in the previous report. Results from this patient suggest that our supposition was correct. Fibrates administration, cessation of the treatment, and monitoring of serum triglyceride level was effective in this case as well as previous reports. Fluorouracil-induced hypertriglyceridemia is associated with the one caused by tegafur and capecitabine and presents the possibility of severe complications. Elucidation of its exact mechanism and epidemiological features is needed for better understanding.
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Project description:IntroductionLenvatinib and Pembrolizumab together are used as a chemotherapy regimen for patients with metastatic endometrial carcinoma. Lenvatinib is a vascular endothelial growth factor (VEGF) receptor inhibitor, fibroblast growth factor inhibitor and an inhibitor that acts on platelet derived growth factor receptor alpha, ret oncogene and c-KIT oncogene. Pembrolizumab is an immune checkpoint inhibitor that acts against programmed-death one (PD-1) receptors and programmed-death ligand one (PD-L1) receptors. In combination, this regimen has proven to be efficacious in the setting of advanced endometrial carcinoma, but this must be weighed against its' side effect profile, most specifically their individual side effects. Pembrolizumab has been associated with pancreatitis. Lenvatinib has been associated with hypertriglyceridemia. However, little has been published with hypertriglyceridemia-induced pancreatitis in the setting of the combination of Lenvatinib and Pembrolizumab and its' management.Case presentationThis case presentation discusses a 57-year-old female with history of stage IV uterine cancer with metastasis to the liver status post total abdominal hysterectomy/bilateral salpingo-oophrectomy (on Lenvatinib 8 mg PO daily/Pembrolizumab 200 mg IV every three weeks) presenting with epigastric pain, nausea, vomiting and decreased appetite; her symptoms were due to hypertriglyceridemia-induced pancreatitis with CT findings consistent with pancreatitis as well as a serum lipase of 1,508, and serum triglyceride level of 2,052; she was treated with IV insulin, resulting in resolution of her hypertriglyceridemia-induced pancreatitis.ConclusionThis case demonstrates a unique presentation of the hypertriglyceridemia induced pancreatitis in the setting of Lenvatinib and Pembrolizumab use and the need for future research to better understand the pathophysiology of the pancreatitis induced by this chemotherapy regimen.
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