Oxaliplatin is an intravenously administered platinum containing alkylating agent which is used for the treatment of advanced colorectal cancer. Oxaliplatin therapy is associated with a low rate of transient serum aminotransferase elevations, but is commonly associated with sinusoidal and vascular injury to the liver which can lead to sinusoidal obstruction syndrome and to nodular regenerative hyperplasia with noncirrhotic portal hypertension.


Oxaliplatin (ox al" i pla' tin) is a cisplatin analog with a tetravalent platinum molecule which is referred to as a platinum coordination complex. Oxaliplatin acts as an alkylating agent causing cross linking between and within DNA strands leading to inhibition of DNA, RNA and protein synthesis and the triggering of programmed cell death, mostly in rapidly dividing cells. Oxaliplatin was approved for use in cancer chemotherapy in the United States in 2002. Its current indications are colorectal carcinoma and it is usually administered in combination with other agents such as 5-fluorouracil (5-FU), irinotecan or capecitabine. Oxaliplatin is available in an aqueous solution for injection in 50, 100 and 200 mg vials in generic forms and under the brand name Eloxatin. The typical dose regimen is a single infusion of oxaliplatin (85 mg/m2) on day 1 of each two-week course with leucovorin and 5-FU. Oxaliplatin should be administered only by health care professions with knowledge and experience in using cancer chemotherapeutic agents and in management of their complications. The platinum based antineoplastic agents have similar toxicities, including nausea and vomiting, diarrhea, bone marrow suppression, as well as neuro-, oto- and nephrotoxicity. They are also mutagenic, teratogenic and carcinogenic, and their use has been associated with an increased risk of secondary leukemias. Uncommon but potentially severe adverse events include anaphylaxis, neuropathy, interstitial pulmonary disease and fibrosis, hepatotoxicity and embryo-fetal toxicity.


Mild and transient elevations in serum aminotransferase levels are found in an appreciable proportion of patients taking oxaliplatin, but their relationship to oxaliplatin is often unclear. Chemotherapy with oxaliplatin has been associated with histological changes in the liver marked by sinusoidal dilatation, congestion and centrolobular necrosis indicative of sinusoidal obstruction syndrome. These changes are usually mild-to-moderate in severity and not clinically significant during the acute phase, but they can progress to clinically apparent sinusoidal obstruction syndrome or, with chronic therapy, to nodular regenerative hyperplasia with splenomegaly, thrombocytopenia and esophageal varices. Nodular regenerative hyperplasia typically requires 6 to 18 months to develop and arises after repeated cycles of chemotherapy with oxaliplatin. Serum enzyme and bilirubin elevations are minimal, the major laboratory finding being a progressive and persistent thrombocytopenia reflecting the development of splenomegaly and portal hypertension. The first clinical evidence of nodular regenerative hyperplasia may be ascites, esophageal variceal hemorrhage or hepatic encephalopathy. Attempts at hepatic resection, severe gastrointestinal bleeding and septicemia may trigger hepatic decompensation and liver failure. Interestingly, nodular regenerative hyperplasia and portal hypertension tend to improve slowly once chemotherapy is stopped, but the long term consequences of the changes are not well defined.

Likelihood score: A (well established cause of clinically apparent liver injury).

Mechanism of Injury

The cause of sinusoidal dilatation and central congestion after oxaliplatin therapy is unknown, but probably relates to injury to sinusoidal endothelial lining cells. While described largely after oxaliplatin therapy, similar changes may occur after therapy with the other platinum coordination complexes, alkylating agents and antimetabolites.

Outcome and Management

The majority of instances of sinusoidal dilatation, vascular injury and congestion found histologically after oxaliplatin therapy occur without significant serum enzyme elevations or clinically apparent liver injury. Rare instances of acute onset of sinusoidal obstruction syndrome with ascites and hepatic failure have been described after oxaliplatin therapy, but usually when given in combination with other antineoplastic agents. Repeated cycles of oxaliplatin and chronic therapy have been linked to nodular regenerative hyperplasia which can be associated with portal hypertension and complications of ascites, variceal hemorrhage and hepatic encephalopathy. There is likely to be cross sensitivity to liver toxicities of the various platinum coordination complexes and continued use or rechallenge after clinically apparent liver injury from oxaliplatin should be avoided. Routine monitoring of liver tests is recommended during courses of oxaliplatin therapy, but evidence of portal hypertension is better assessed using serial platelet counts or repeated radiologic evaluation of spleen size.

Drug Class: Antineoplastic Agents, Alkylating Agents

Other Drugs in the Subclass, Platinum Coordination Complexes: Carboplatin, Cisplatin



Oxaliplatin – Generic, Eloxatin®


Antineoplastic Agents, Alkylating Agents


Product labeling at DailyMed, National Library of Medicine, NIH



References updated: 12 September 2020

  • Abbreviations: BMI, body mass index; CT, computerized tomography; NRH, nodular regenerative hyperplasia; SOS, sinusoidal obstruction syndrome; HVPG, hepatic venous pressure gradient; SAMe, S-adenosylmethionine.
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    (Among 40 patients with colorectal cancer undergoing hepatic resection for metastases after oxaliplatin based chemotherapy, 23 had SOS which was severe in 11 patients who had higher hyaluronic acid levels than the 29 with mild or no injury [52 vs 29 ng/mL]).
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    (Retrospective analysis of 151 patients with colorectal cancer and hepatic metastases; SOS occurred in 60 of 67 [90%] of those who received oxaliplatin and fluorouracil alone and was severe in 37 [55%], but arose in only 6 of 10 who received both oxaliplatin and bevacizumab and was severe in only 1 [10%]).
  • Wolf PS, Park JO, Bao F, Allen PJ, DeMatteo RP, Fong Y, Jarnagin WR, et al. Preoperative chemotherapy and the risk of hepatotoxicity and morbidity after liver resection for metastatic colorectal cancer: a single institution experience. J Am Coll Surg. 2013;216:41–9. [PubMed: 23041049]
    (Among 506 patients undergoing hepatic resection for colorectal cancer, histologic evaluation of non-tumor parenchyma showed that steatohepatitis was associated with irinotecan regimens, higher BMI and diabetes, whereas sinusoidal dilatation was not associated with chemotherapy; neither chemotherapy or liver histology correlated with complications or deaths).
  • Urdzik J, Bjerner T, Wanders A, Duraj F, Haglund U, Norén A. Magnetic resonance imaging flowmetry demonstrates portal vein dilatation subsequent to oxaliplatin therapy in patients with colorectal liver metastasis. HPB (Oxford). 2013;15:265–72. [PMC free article: PMC3608980] [PubMed: 23458313]
    (Prospective monitoring by magnetic resonance imaging found that oxaliplatin chemotherapy was associated with portal vein dilatation independent of sinusoidal injury, but that a combination of measurements of portal velocity and cross sectional area was predictive of the finding of sinusoidal injury).
  • Béchade D, Désolneux G, Fonck M, Soubeyran I, Bécouarn Y, Evrard S. Presse Med. 2013;42:102–7. [Regenerative nodular hyperplasia of the liver related to oxaliplatin-based chemotherapy] [PubMed: 22770975]
    (Two cases of NRH in a man and woman, age 60 years, with metastatic colorectal cancer after 17 and 12 courses of oxaliplatin based chemotherapy).
  • Vreuls CP, Olde Damink SW, Koek GH, Winstanley A, Wisse E, Cloots RH, van den Broek MA, et al. Glutathione S-transferase M1-null genotype as risk factor for SOS in oxaliplatin-treated patients with metastatic colorectal cancer. Br J Cancer. 2013;108:676–80. [PMC free article: PMC3593549] [PubMed: 23287989]
    (Among 55 patients with metastatic colorectal cancer who received oxaliplatin chemotherapy, the glutathione S-transferase [GST] M1-null polymorphism was frequent in those who developed moderate or severe sinusoidal injury [12 of 17: 70%] than in those with no or mild injury [13 of 38: 34%]).
  • Ogata H, Gushima T, Maruoka S, Takasaki S, Tanaka R, Matsuura T, Aishima S, et al. A case of portal hypertension after 5-fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6) chemotherapy. Nihon Shokakibyo Gakkai Zasshi. 2013;110:2119–26. [PubMed: 24305101]
    (46 year old man developed noncirrhotic portal hypertension after 10 cycles of oxaliplatin and fluorouracil for colorectal cancer metastases, and required endoscopic ligation and transvenous obliteration of bleeding esophageal varices).
  • Uchino K, Fujisawa M, Watanabe T, Endo Y, Nobuhisa T, Matsumoto Y, Kai K, et al. Oxaliplatin-induced liver injury mimicking metastatic tumor on images: a case report. Jpn J Clin Oncol. 2013;43:1034–8. [PubMed: 23958518]
    (47 year old man developed radiologically apparent hepatic masses after 6 cycles of oxaliplatin and fluorouracil for metastatic colorectal cancer which, on resection, were not tumors but represented severe sinusoidal dilatation and congestion).
  • Lu QY, Zhao AL, Deng W, Li ZW, Shen L. Hepatic histopathology and postoperative outcome after preoperative chemotherapy for Chinese patients with colorectal liver metastases. World J Gastrointest Surg. 2013;5:30–6. [PMC free article: PMC3615301] [PubMed: 23556058]
    (Retrospective analysis of 106 patients undergoing hepatic resection for colorectal cancer at a single Chinese medical center over a 10 year period, found that oxaliplatin based regimens were associated with sinusoidal dilation [42%] compared to surgery only controls [21%], but perioperative complication rates were similar).
  • Nguyen-Khac E, Lobry C, Chatelain D, Fuks D, Joly JP, Brevet M, Tramier B, et al. A Reappraisal of chemotherapy-induced liver injury in colorectal liver metastases before the era of antiangiogenics. Int J Hepatol. 2013;2013:314868. [PMC free article: PMC3606725] [PubMed: 23533786]
    (Among 50 patients with colorectal cancer undergoing hepatectomy after chemotherapy, 55% of those who received oxaliplatin developed sinusoidal dilatation and 23% had evidence of NRH compared to 23% and 6% of controls; however, there was no difference in overall mortality or outcomes).
  • Schwarz RE, Berlin JD, Lenz HJ, Nordlinger B, Rubbia-Brandt L, Choti MA. Systemic cytotoxic and biological therapies of colorectal liver metastases: expert consensus statement. HPB (Oxford). 2013;15:106–15. [PMC free article: PMC3719916] [PubMed: 23297721]
    (Summary of current optimal therapies of patients with colorectal liver metastases and the problem of chemotherapy associated liver injury, particularly to oxaliplatin [SOS, NRH] and irinotecan [steatosis] leading to recommendation that, if possible, preoperative chemotherapy be limited to 3 months).
  • Morine Y, Shimada M, Utsunomiya T. Evaluation and management of hepatic injury induced by oxaliplatin-based chemotherapy in patients with hepatic resection for colorectal liver metastasis. Hepatol Res. 2014;44:59–69. [PubMed: 23551330]
    (Review of the frequency, clinical significance and management of hepatic effects of oxaliplatin therapy in patients undergoing liver resection for colorectal cancer metastases).
  • Morris-Stiff G, White AD, Gomez D, Cameron IC, Farid S, Toogood GJ, Lodge JP, et al. Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases. Eur J Surg Oncol. 2014;40:1016–20. [PubMed: 24370284]
    (Retrospective review of 978 patients who underwent hepatic resection for colorectal cancer metastases at a single institution in the UK between 2000 and 2010, identified 5 who developed clinically apparent NRH, all had received at least 6 cycles of oxaliplatin and fluorouracil, but only 1 had hepatic failure which was reversible and the all deaths [n=4] were due to cancer recurrence).
  • Seo AN, Kim H. Sinusoidal obstruction syndrome after oxaliplatin-based chemotherapy. Clin Mol Hepatol. 2014;20:81–4. [PMC free article: PMC3992335] [PubMed: 24757663]
    (58 year old Korean woman with metastatic colon cancer underwent 6 cycles of chemotherapy with capecitabine and oxaliplatin and subsequent hemihepatectomy, the normal liver showing marked SOS despite normal liver tests [bilirubin 0.8 mg/dL, ALT 12 U/L, Alk P 60 U/L, INR 1.1] indicating the frequent silent nature of SOS).
  • Nalbantoglu IL, Tan BR Jr, Linehan DC, Gao F, Brunt EM. Histological features and severity of oxaliplatin-induced liver injury and clinical associations. J Dig Dis. 2014;15:553–60. [PubMed: 25060628]
    (Among 47 patients with metastatic colon cancer undergoing liver resection after oxaliplatin based chemotherapy, 32 [68%] had changes indicative of SOS [using a scoring system of 0 to 4], which was moderate or severe in 26 [55%] and usually associated with serum aminotransferase abnormalities; liver also showing capillarization, sinusoidal fibrosis and hepatocyte proliferation).
  • Tajima H, Ohta T, Miyashita T, Nakanuma S, Matoba M, Miyata T, Sakai S, et al. Oxaliplatin-based chemotherapy induces extravasated platelet aggregation in the liver. Mol Clin Oncol. 2015;3:555–8. [PMC free article: PMC4471568] [PubMed: 26137266]
    (Analysis of 32 patients with metastatic colorectal cancer undergoing hepatic resection demonstrated lower platelet counts [167,000 vs 227,000/µL], larger spleen volumes, and prominent aggregation of platelets in zone 3 in those who had received adjuvant oxaliplatin [n=17] vs controls [n=15]).
  • Viganò L, Rubbia-Brandt L, De Rosa G, Majno P, Langella S, Toso C, Mentha G, et al. Nodular regenerative hyperplasia in patients undergoing liver resection for colorectal metastases after chemotherapy: risk factors, preoperative assessment and clinical impact. Ann Surg Oncol. 2015;22:4149–57. [PubMed: 25845431]
    (Among 406 patients undergoing 478 liver resections for metastatic colorectal cancer at two European medical centers between 2015 and 2017, 68% had sinusoidal dilatation, 25% had steatosis, 10% had steatohepatitis and 18% had NRH, risk factors for NRH being preoperative oxaliplatin and low platelet counts but not routine liver test abnormalities).
  • Choi JH, Won YW, Kim HS, Oh YH, Lim S, Kim HJ. Oxaliplatin-induced sinusoidal obstruction syndrome mimicking metastatic colon cancer in the liver. Oncol Lett. 2016;11:2861–4. [PMC free article: PMC4812530] [PubMed: 27073565]
    (22 year old woman with resected colon cancer presented after 5 cycles of adjuvant chemotherapy with minor liver test abnormalities [bilirubin 0.6 mg/dL, ALT 51 U/L, Alk P 105 U/L] and enlarging nodular hepatic lesions on abdominal CT which at surgery were areas of dark red congested liver which represented areas of severe SOS histologically).
  • Stevenson HL, Prats MM, Sasatomi E. Chemotherapy-induced sinusoidal injury (CSI) score: a novel histologic assessment of chemotherapy-related hepatic sinusoidal injury in patients with colorectal liver metastasis. BMC Cancer. 2017;17:35. [PMC free article: PMC5219653] [PubMed: 28061766]
    (Immunohistochemistry done on 30 liver samples from hepatic resections for metastatic colorectal cancer found aberrant CD34 staining [marker for platelets] more frequently in 22 cases with SOS vs 8 controls [82% vs 25%] as well as multifocal increases in smooth muscle actin staining [72% vs 25%] and glutamine synthetase staining [32% vs none]; the combination of the 3 stains being possibly helpful in diagnosis of SOS).
  • Vigano L, De Rosa G, Toso C, Andres A, Ferrero A, Roth A, Sperti E, et al. Reversibility of chemotherapy-related liver injury. J Hepatol. 2017;67:84–91. [PubMed: 28284915]
    (Among 15 patients with colorectal cancer who underwent two hepatic resections more than 270 days apart without interval chemotherapy, SOS regressed in 4 of 5 patients who had SOS initially and NRH in 7 of 8 patients, whereas neither steatosis [3 of 3] or steatohepatitis [2 of 2] resolved).
  • Duwe G, Knitter S, Pesthy S, Beierle AS, Bahra M, Schmelzle M, Schmuck RB, et al. Hepatotoxicity following systemic therapy for colorectal liver metastases and the impact of chemotherapy-associated liver injury on outcomes after curative liver resection. Eur J Surg Oncol. 2017;43:1668–81. [PubMed: 28599872]
    (Review of the hepatotoxicity of chemotherapies for metastatic colorectal cancer, focusing on fluorouracil [steatosis], irinotecan [steatohepatitis] and oxaliplatin [SOS] and including analysis of the contribution of anti-EGFR antibodies and bevacizumab on both efficacy and safety).
  • Wakiya T, Kudo D, Ishido K, Kimura N, Yakoshi Y, Toyoki Y, Kijima H, et al. Effect of age on the development of chemotherapy-associated liver injury in colorectal cancer liver metastasis. Mol Clin Oncol. 2017;7:200–4. [PMC free article: PMC5532632] [PubMed: 28781785]
    (Among 64 patients with metastatic colorectal cancer receiving oxaliplatin-based adjuvant chemotherapy, sinusoidal injury occurred in 27-30% and steatohepatitis in 35-40% of patients, rates being similar in all age groups).
  • Bernichon E, Daguenet E, Molla C, Cornillon J, Lejeune C, Casteillo F, Guyotat D, et al. Sinusoidal obstruction syndrome/veno-occlusive disease complication in lymphoma patients treated with oxaliplatin-based regimen: A case series report. Curr Res Transl Med. 2018;66:107–10. [PubMed: 29519713]
    (Among 49 patients with lymphoma receiving autologous hematopoietic cell transplantation over a 2 year period at a single, French referral center, 4 of 19 who had received oxaliplatin-based cycles of chemotherapy developed severe SOS within 2-9 days compared to none of 30 who did not receive oxaliplatin).
  • Shigefuku R, Watanabe T, Mizukami T, Matsunaga K, Hattori N, Ehira T, Suzuki T, et al. Esophagogastric varices were diagnosed in a non-cirrhotic liver case during long-term follow-up after oxaliplatin-based chemotherapy. Clin J Gastroenterol. 2018;11:487–92. [PubMed: 29948819]
    (78 year old Japanese man presented with esophageal varices and splenomegaly 3.5 years after receiving 10 cycles of oxaliplatin and fluorouracil for metastatic colorectal cancer [bilirubin1.0, ALT 16 U/L, Alk P 269 U/L, platelets 65,000/µL], liver biopsy showing no evidence of fibrosis).
  • Overman MJ, Ferrarotto R, Raghav K, George B, Qiao W, Machado KK, Saltz LB, et al. The addition of bevacizumab to oxaliplatin-based chemotherapy: impact upon hepatic sinusoidal injury and thrombocytopenia. J Natl Cancer Inst. 2018;110:888–94. [PubMed: 29346573]
    (Among 184 patients with metastatic colorectal cancer treated with adjuvant fluorouracil and oxaliplatin with or without bevacizumab, the rate of splenomegaly and thrombocytopenia in follow up was less in those receiving bevacizumab).
  • Gutierrez L, Méndez S, Mitjavila M, Llop E, Salas C, Ruiz-Casado A. Noncirrhotic portal hypertension: an under-reported late adverse event of SIRT in metastatic colorectal cancer patients. J Cancer Res Ther. 2019;15:42–7. [PubMed: 30880753]
    (Three patients with metastatic colorectal cancer developed noncirrhotic portal hypertension after cycles of fluorouracil and oxaliplatin and then selective internal radiation therapy with 90-yttrium-radiolabeled microspheres, two later dying of hepatic failure).
  • Corbacioglu S, Jabbour EJ, Mohty M. Risk factors for development of and progression of hepatic veno-occlusive disease/sinusoidal obstruction syndrome. Biol Blood Marrow Transplant. 2019;25:1271–80. [PubMed: 30797942]
    (Review of the risks, clinical features and management of chemotherapy induced SOS focusing upon oxaliplatin and the more recent causes, gemtuzumab ozogamicin and inotuzumab ozogamicin).
  • Hisaka T, Ishikawa H, Sakai H, Kawahara R, Goto Y, Nomura Y, Yasunaga M, et al. Sinusoidal obstruction syndrome and postoperative complications resulting from preoperative chemotherapy for colorectal cancer liver metastasis. Anticancer Res. 2019;39:4549–54. [PubMed: 31366558]
    (Among 90 cases of metastatic colorectal cancer treated with adjuvant chemotherapy before hepatic resection, rates of sinusoidal injury in the resected nontumorous liver were similar in those who received no monoclonal antibody vs bevacizumab or cetuximab or panitumumab [50% to 51%], but the degree of injury appeared less with bevacizumab).
  • Wilcox MA, Hardin J, Weaver J, Voss EA. Liver test monitoring: real-world compliance for drugs with monitoring requirements at 2-week intervals or more frequently. Pharmaceut Med. 2019;33:389–94. [PubMed: 31933226]
    (Analysis of 3 large health databases for compliance with recommendations for liver test monitoring when initiating therapy with 9 drugs found compliance was highest for oxaliplatin [75%], somewhat lower for rifampin [68%], tolcapone [67%], albendazole [66%] and azathioprine [61%], and poor for pentamidine [21%], felbamate [22%], succimer [29%] and ketoconazole [32%]).
  • Fujii A, Tateoka T, Okuyama T, Matsushima J, Sato T, Ono Y, Ban S. Uneven distribution of histologic changes of "blue liver" induced after oxaliplatin-based chemotherapy for colon cancer. Int J Surg Pathol. 2020;28:523–5. [PubMed: 31623475]
    (50 year old woman with metastatic colorectal cancer underwent 8 courses of oxaliplatin and capecitabine followed by hepatic resection that revealed mottled red areas of the nontumorous liver with changes of SOS).
  • Honda S, Tsujimoto M, Minegaki T, Mori T, Muraoka J, Nishiguchi K. A case of idiosyncratic liver injury after oxaliplatin-induced thrombocytopenia. J Clin Pharm Ther. 2020;45:373–5. [PubMed: 31671217]
    (46 year old woman with metastatic colorectal carcinoma experienced an anaphylactic reaction to a second infusion of oxaliplatin with subsequent abnormal liver tests [bilirubin 0.8 rising to 1.4 mg/dL, ALT 110 to 1010 U/L, Alk P 281 to 313 U/L], with profound thrombocytopenia [7000/µL] and rapid resolution within 2-3 weeks with prednisone therapy).
  • Puente A, Fortea JI, Del Pozo C, Huelin P, Cagigal ML, Serrano M, Cabezas J, et al. Porto-sinusoidal vascular disease associated to oxaliplatin: an entity to think about it. Cells. 2019;8:1506. [PMC free article: PMC6952805] [PubMed: 31771307]
    (Review of NRH arising after oxaliplatin therapy including possible pathogenesis, criteria for diagnosis and recommendations for management).
  • Debureaux PE, Febvre de Nailly DL, Tavernier E, Bedoui M, Kuhnowski F, Tamburini J, et al. Sinusoidal obstruction syndrome: a warning about autologous stem cell transplantation preceded by regimens containing oxaliplatin. Bone Marrow Transplant. 2020;55:1834–6. [PubMed: 31959893]
    (Among 23 patients with SOS after autologous HCT for lymphoma identified in a French national survey, 21 had received oxaliplatin compared to only 13 of 23 matched controls).
  • Eren T, Pasaoglu L. Splenomegaly in colon cancer during adjuvant oxaliplatin-based chemotherapy. Cureus. 2020;12:e7230. [PMC free article: PMC7145381] [PubMed: 32280572]
    (Among 50 patients with metastatic colorectal cancer who received fluorouracil and oxaliplatin between 2015 and 2017, 50% developed splenomegaly [>50% increase in spleen size by CT], which correlated best with total oxaliplatin dose received and development of thrombocytopenia after therapy).
  • Morioka D, Izumisawa Y, Yamaguchi K, Sato K, Komiyama S, Nakagawa K, Kakizoe M, et al. Surgical intervention for portal hypertension caused by oxaliplatin-based chemotherapy: a case report and a review of literature regarding radiological and/or surgical interventions for oxaliplatin-associated portal hypertension. Clin J Gastroenterol. 2020 Jun 26; Epub ahead of print. [PMC free article: PMC7519904] [PubMed: 32592150]
    (63 year old man developed recurrent variceal hemorrhage, ascites and hydrothorax after oxaliplatin therapy of metastatic colon cancer followed by hepatic resection who was treated with splenectomy and portocaval shunt, with resolution of the complications of portal hypertension).
  • Al-Qudah G, Ghanem M, Blebea J, Shaheen S. Blue liver: case report of blue liver. Am J Case Rep. 2020;21:e923553. [PMC free article: PMC7423174] [PubMed: 32738134]
    (39 year old man with acute cholestatic liver disease of unknown cause [bilirubin 14 to 21 mg/dL, ALT 185 U/L, Alk P 150 U/L INR 1.2] was found to have a blue liver on laparoscopic cholecystectomy, later improving on long term ursodiol therapy; no exposure to oxaliplatin and blue color not explained; jaundice possibly due to unacknowledged anabolic steroid use).
  • Di Federico A, Nuvola G, Sisi M, Lenzi B, Nobili E, Campana D. Hyperammonemic encephalopathy during XELOX regimen. is it capecitabine or oxaliplatin responsible? Anticancer Drugs. 2020 Aug 19; Epub ahead of print. [PubMed: 32826413]
    (65 year old man with refractory metastatic lung carcinoid tumor developed confusion and coma 11 days into a 3-week regimen of capecitabine [1.6 mg/m2 daily for 15 days] and oxaliplatin [104 mg/m2 on day 1] with ammonia of 167 µmol/L but normal bilirubin and aminotransferase levels, resolving within 3 days of stopping capecitabine).