BMJ Case Reports 2018; doi:10.1136/bcr-2017-222969
  • Unexpected outcome (positive or negative) including adverse drug reactions

Hepatotoxicity Associated With Vismodegib

  1. Heather Laird-Fick4
  1. 1Department of Internal Medicine, UPMC East, Monroeville, Pennsylvania, USA
  2. 2Internal Medicine, Michigan State University / Sparrow Hospital, Lansing, Michigan, United States of America
  3. 3Department of Hematology/Oncology, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
  4. 4Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
  1. Correspondence to Dr Manoj P Rai, manojrai029{at}
  • Accepted 27 January 2018
  • Published 8 February 2018


An 82-year-old Caucasian woman with a history of basal cell carcinoma on vismodegib presented with nausea, vomiting and intermittent abdominal pain. Laboratory results were remarkable for the elevation of liver enzymes. Endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangiogram (PTC) did not show evidence of intrahepatic or extrahepatic obstruction of the biliary tract. During PTC external biliary catheter was placed; however, bilirubin continued to rise. Further, laboratory work-up and imaging studies ruled out other possible aetiologies for hepatotoxicity such as infections, autoimmune hepatitis and other drugs known to be hepatotoxic thus leaving vismodegib the most likely cause of hepatotoxicity.


  • Contributors PSB contributed mainly to the case description, he also prepared the graphs and was also responsible for obtaining the consent . MPR contributed to the summary, background, discussion and learning points. NT provided recommendations on improving the case, later revised the manuscript. HL-F: revised the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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