Recombinant Factor VIIa in the Management of Pulmonary Hemorrhage Associated With Metastatic Choriocarcinoma

hepatomegaly was observed despite discontinuation of chemotherapy after cisplatin and only 3 days of capecitabine. Finally, cisplatin is nephrotoxic, and therefore would potentially have aggravated azotemia that was complicated by TLS. Although there may be a possibility that azotemia was attributed to nephrotoxicity of cisplatin in the present case, it is less likely because nephrotoxicity of cisplatin is typically accompanied by nonoliguric azotemia and develops slowly and predictably after repeated exposure, unlike this case. Considering our experience, precautions should be taken to avoid this potentially fatal complication when treating even solid tumors, especially therapy-sensitive tumors presenting with bulky or rapidly progressive disease and pre-existing risk factors, such as azotemia, an elevated LDH, and hyperuricemia. To the best of our knowledge, this is the first case report describing TLS following chemotherapy for AGC. Although TLS occurs rarely in patients with solid tumors including AGC, bulky tumors with a rapid doubling time or high sensitivity to antineoplastic treatments can induce TLS. Patients at risk require adequate monitoring and preventive measures, and appropriate therapeutic measures must be initiated promptly when TLS is encountered. Hye-Suk Han, Sook Ryun Park, Sun Young Kim, Young Iee Park, Jong Seok Lee, Myeong-Cherl Kook, Il Ju Choi, Chan Gyoo Kim, Jong Reul Lee, Soo Jeong Cho, and Noe Kyeong Kim Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Republic of Korea