• Maito Suoh, Atsushi Hagihara, Masafumi Yamamura, Hirotsugu Maruyama, Koichi Taira, Masaru Enomoto, Akihiro Tamori, Yasuhiro Fujiwara, and Norifumi Kawada.
• Department of Hepatology, Graduate School of Medicine, Osaka City University, Japan.
• Intern. Med. 2021 Feb 15; 60 (4): 545-552.

AbstractAn 82-year-old man with hepatocellular carcinoma presented with upper abdominal pain, vomiting, and jaundice. He had been taking a standard lenvatinib dose for three months. Although acute cholangitis was suggested, imaging studies failed to detect the biliary obstruction site. An endoscopic examination following discontinuation of lenvatinib and aspirin revealed multiple duodenal ulcers, one of which was formed on the ampulla of Vater and causing cholestasis. Endoscopic biliary drainage and antibiotics improved concomitant Enterobacter cloacae bacteremia. Ulcer healing was confirmed after rabeprazole was replaced with vonoprazan and misoprostol. Our case shows that lenvatinib can induce duodenal ulcers resulting in obstructive jaundice.

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