• Keisuke Uchida, Yoshinori Ozono, Naomi Uchiyama, Hiroshi Hatada, Kenichi Nakamura, Yuri Komaki, Hisayoshi Iwakiri, Satoru Hasuike, Kenji Nagata, Yuichiro Sato, and Hiroshi Kawakami.
• Divison of Gastroenterology and Hepatology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan.
• Medicine (Baltimore). 2022 Sep 2; 101 (35): e30486.

RationaleHepatocellular carcinoma (HCC) is the sixth most common type of cancer globally. Since 2020, combination treatment with atezolizumab and bevacizumab were approved in patients with unresectable HCC in Japan, and atezolizumab plus bevacizumab is the first-line treatment for unresectable HCC.Patient ConcernsA 73-year-old Japanese man diagnosed with a large HCC was treated with atezolizumab plus bevacizumab. After 2 cycles, he had fever and fatigue and was admitted to the hospital.DiagnosisAbdominal contrast-enhanced computed tomography revealed tumor necrosis in HCC with gas formation in the necrotic area. Laboratory examination revealed a white blood cell (WBC) count of 16,340/μL and C-reactive protein (CRP) level of 33.0 mg/dL. Based on the above findings, he was diagnosed with a liver abscess.InterventionsPercutaneous transhepatic liver abscess drainage and broad-spectrum antibiotics treatment were performed.OutcomesDespite liver abscess drainage, persistent fever and no improvement in the WBC count or CRP level was observed. The patient's respiratory condition and renal function gradually worsened; The patient's general condition did not improve despite the ventilator support and continuous hemodiafiltration, and he died on day 37.LessonsWe report the first case of liver abscess after atezolizumab plus bevacizumab treatment for unresectable HCC.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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