Abstract
An 86-year-old man presented with recurrence of hepatocellular carcinoma (HCC) after surgery. Atezolizumab plus bevacizumab was initiated. After the third course of atezolizumab plus bevacizumab therapy, petechial purpura appeared on the extremities and trunk. Laboratory tests revealed isolated severe thrombocytopenia without evidence of combined coagulopathy. He was diagnosed with immune thrombocytopenic purpura (ITP), and high-dose immunoglobulin and Helicobacter pylori eradication therapies were administered. Improvement in thrombocytopenia was observed; however, 20 days after the onset of ITP, laboratory data revealed hemolytic anemia. Both direct and indirect Coombs tests were positive, and he was diagnosed with Evan’s syndrome complicated by ITP and autoimmune hemolytic anemia (AIHA) induced by immune-related adverse events (irAEs). After treatment with prednisolone, the hemoglobin level increased, and hemolytic findings improved on blood tests. We encountered a rare case of Evans’ syndrome due to atezolizumab plus bevacizumab therapy for HCC. In atezolizumab plus bevacizumab therapy, hematologic toxicities are not rare adverse events and attention is required.
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All the authors contributed to the conception and design of the study. Material preparation, data collection, and analyses were performed by MF, KT, RS, YN, KT, EO, SM, TK, HM, and KN. The first draft of the manuscript was written by MF, and all authors contributed to previous versions of the manuscript. All authors have read and approved the final manuscript.
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Fukushima, M., Tajima, K., Sasaki, R. et al. Evans’ syndrome induced by atezolizumab plus bevacizumab combination therapy in advanced hepatocellular carcinoma. Clin J Gastroenterol 16, 402–406 (2023). https://doi.org/10.1007/s12328-023-01767-0
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DOI: https://doi.org/10.1007/s12328-023-01767-0