Pegylated L-Asparaginase Induced Cholestatic Jaundice and Treated With Oral L-Carnitine: A Case Report

Abstract

Various chemotherapeutic regimens are available for the treatment of acute lymphoblastic leukemia (ALL). While providing improved cure rates these regimens are also associated with various systemic toxicities including hepatotoxicity. L-Asparaginase is a commonly used drug in various combination regimens for the treatment of both adult and childhood ALL. Most commonly observed side effect is hypersensitivity followed by liver injury. 85% of all the patients treated with L-Asparaginase develop hepatic steatosis whereas Cholestatic jaundice is infrequently seen. Timely identification and management of this entity can prevent progression to fatal liver failure.We, here, describe a patient of acute lymphoblastic leukemia diagnosed on bone marrow biopsy and immunophenotyping who developed Cholestatic jaundice after induction chemotherapy using L-Asparaginase, Vincristine, Daunorubicin and Dexamethasone. He was identified earlier and was given a good supportive management along with holding chemotherapy. He recovered within a span of two weeks and is on maintenance chemotherapy doing well on last follow up.