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Case report
Tumour-bowel fistula as a possible complication of pazopanib therapy in retroperitoneal leiomyosarcoma
  1. Rodrigo Otavio Lami Pereira1,
  2. Payal R Patel2,
  3. Pramod K Guru1 and
  4. Devang K Sanghavi1
  1. 1 Critical Care Medicine, Mayo Clinic, Jacksonville, Florida, USA
  2. 2 Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Rodrigo Otavio Lami Pereira; lamipereira.rodrigo{at}


Pazopanib is a vascular endothelial growth factor receptor tyrosine kinase inhibitor (VEGFR TKI) that inhibits the vascular endothelial growth factor receptor A pathway and has the potential to cause ischaemic bowel changes, including perforation. Here we report a case of a 51-year-old man with large, metastatic, retroperitoneal leiomyosarcoma that developed a tumour-bowel fistula after 4 weeks of pazopanib therapy. He presented to the emergency department with sepsis and 1-week history of worsening fever, chills, nausea and diarrhoea. Abdominal CT findings of mesenteric and portal vein gas, commonly found in mesenteric ischaemia and VEGFR modulator-induced bowel toxicity, provided evidence for the causal relation. Unfortunately, the case was not amenable to surgery and patient succumbed to the illness.

  • tyrosine kinase inhibitor
  • adult intensive care
  • chemotherapy
  • unwanted effects/adverse reactions

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  • Twitter @LamiPereira, @pkguru10

  • Contributors ROLP performed literature review, acquired data, obtained informed consent and wrote the manuscript. PRP performed literature review and edited the manuscript. PKG reviewed the manuscript. DKS reviewed the manuscript. All authors were directly involved in patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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