Lenvatinib-induced acute acalculous cholecystitis in a patient with hepatocellular carcinoma

Kazunaga Ishigaki, Tsuyoshi Hamada, Yousuke Nakai, Yuki Ishigaki, Hiroki Oyama, Sachiko Kanai, Tatsunori Suzuki, Tomoka Nakamura, Tatsuya Sato, Ryunosuke Hakuta, Kei Saito, Tomotaka Saito, Naminatsu Takahara, Suguru Mizuno, Hirofumi Kogure, Ryosuke Tateishi, Minoru Tada, Kazuhiko Koike

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


The patient was a 67-year-old man with advanced hepatocellular carcinoma (HCC) due to chronic hepatitis B. Due to refractoriness to radiofrequency ablation and transcatheter arterial chemoembolization, lenvatinib, a new oral mutikinase inhibitor, was started with a daily dose of 12 mg. However, on day 6 the patient developed acute-onset, right upper quadrant pain associated with fever; laboratory tests revealed leukocytosis and liver dysfunction. CT scan showed the swollen gallbladder with wall thickening with no evidence of gallstones, and the diagnosis of acute acalculous cholecystitis was made. After the resolution of cholecystitis by antibiotics and endoscopic nasogallbladder drainage placement, lenvatinib was resumed at a reduced daily dose of 4 mg. However, acute acalculous cholecystitis recurred, supporting lenvatinib as a cause of acute acalculous cholecystitis. Using the Naranjo adverse drug reaction probability scale, a score of 6 was derived, which indicates that this adverse event was probably caused by lenvatinib. In summary, we present a patient with advanced HCC who underwent repeated episodes of acute acalculous cholecystitis as a rare adverse event associated with lenvatinib.

Original languageEnglish
Pages (from-to)568-571
Number of pages4
JournalClinical Journal of Gastroenterology
Issue number4
Publication statusPublished - 1 Aug 2020
Externally publishedYes


  • Acute acalculous cholecystitis
  • Hepatocellular carcinoma
  • Lenvatinib


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