Increasing Jaundice Secondary to an Acute Toxic Hepatitis Induced by Levofloxacin in a 20-year-old Man with a Fibrolamellar Hepatocarcinoma

Introduction: Levofloxacin-induced liver injury is rare and usually mild and transient. Presentations in the form of acute fulminant hepatitis are extremely uncommon.Presentation of the case: We report the case of a 20-year old man with a fibrolamellar hepatocellular carcinoma (fHCC), with affected retroperitoneal lymph nodes but no hepatic disease involvement. After receiving levofloxacin for the treatment of a community-acquired pneumonia, he developed hyperbilirrubinemia and abnormal liver function tests in the context of an acute cholestasic toxic hepatitis. In spite of optimal supportive treatment, that included admission in the Intensive Unit Care and extracorporeal albumin dialysis detoxification, the patient developed a rapidly progressive liver failure and died a month after the beginning of the process. The necropsy findings confirmed extensive drug-induced hepatic necrosis. No liver involvement by the fHCC was found in the autopsy.Conclusion: Rarer intercurrent conditions, such as drug-induced hepatotoxicity, should be taken into account in cancer patients with deranged liver function tests, even in those patients with advanced disease.

Bilateral pulmonary nodules after the successful treatment of a mediastinal seminoma

Germ cell tumors are unusual, but they represent the most common neoplasm in young men. Since the introduction of cisplatin-based chemotherapy, most cases are expected to be cured today. Intensive monitoring of these patients during follow-up is required to rule out relapses or late complications of therapy. We present the case of a 21-year-old male who developed extensive lung dissemination by Langerhans cell histiocytosis eight months after the successful treatment of a bulky mediastinal seminoma.

Bilateral pulmonary nodules after the successful treatment of a mediastinal seminoma

Germ cell tumors are unusual, but they represent the most common neoplasm in young men. Since the introduction of cisplatin-based chemotherapy, most cases are expected to be cured today. Intensive monitoring of these patients during follow-up is required to rule out relapses or late complications of therapy. We present the case of a 21-year-old male who developed extensive lung dissemination by Langerhans cell histiocytosis eight months after the successful treatment of a bulky mediastinal seminoma.  </p