A case of hepatitis C-related cirrhosis that developed cancer of unknown primary origin and followed with fulminant course after treatment with direct-acting antivirals

Abstract

Here, we present a case of a female patient who was in her 70s. She was treated with IFN for hepatitis C-related compensated cirrhosis 8 years ago but had discontinued the treatment. She was given Daclatasvir hydrochloride+Asunaprevir 4 years ago; however, it was ineffective. She was given Sofosbuvir+Velpatasvir+Ribavirin 2 years and 4 months ago, and achieved SVR. She underwent partial hepatectomy, 7 months ago, for a single-moderately differentiated-3 cm hepatocellular carcinoma. In January X, she was admitted to the hospital because of multiple intrahepatic tumors shown on MRI. Further evaluation revealed tumors in the breasts and upper left arm and the patient died 1 month after admission. The pathological autopsy revealed that multiple systemic tumors were adenocarcinoma of unknown primary origin, except one hepatic tumor that was hepatocellular carcinoma. There are few reports of developing solid cancers other than hepatocellular carcinoma after treatment with direct-acting antivirals. Here, we report a similar case with a review of previously published literature on the same.