A Case Report of Guillain-Barre Syndrome Induced by Transcatheter Chemoembolization after Percutaneous Transhepatic Portal Embolization Analyzed by Cytokines

Percutaneous transhepatic portal embolization (PTPE) for preconditioning is often employed in hepatobiliary surgery for major hepatectomy. We report a case of Guillain-Barre syndrome after PTPE. A 68-year-old man was admitted to our hospital because of a liver tumor. The tumor was located in segment 8, along the middle and right hepatic vein. Preoperative evaluation of this patient, suggested determined that an extended right hepatic lobectomy or more was necessary. PTPE was performed before hepatectomy. CT was done two weeks after PTPE, which indicated that the left lobe was enlarged by 117%, however, based on the other laboratory data and patient's performance status, a major hepatectomy did not seem to be indicated. We therefore decided to do a trans-arterial chemoembolization (TACE) first. After five days, the patient had a slight fever and leukocytosis, both of which had resolved by the ninth day. On the twelfth day after TACE, the patient had quadriplegia, anarthria, dyspnea, and vertigo. A neurosurgeon diagnosed the patient as having Guillain-Barre syndrome. We checked the cytokines, HGF, IL-6, IL-1β and TGF-β1, in five patients including this patient. In this study, only IL-6 was increased about twelve fold after PTPE. Some immunological over-reaction probably occurred, resulting in Guillain-Barre syndrome. Because PTPE may have unknown side effects, it should be used only after careful deliberation.