Ascites Presenting as a Peritonitis‐Like Manifestation and Liver Injury due to Trabectedin Monotherapy in a Patient With Myxoid Liposarcoma

BACKGROUND: Trabectedin is a synthetic, marine-derived antitumor agent that exerts cytotoxic effects by binding to the minor groove of DNA. While trabectedin has demonstrated efficacy in advanced soft tissue sarcomas, hepatotoxicity and other adverse events remain concerns. However, cases involving drug-induced liver injury with ascites are rare. CASE PRESENTATION: We report a case of an 82-year-old woman with recurrent metastatic myxoid liposarcoma who developed simultaneous liver dysfunction and ascites after 12 cycles of trabectedin monotherapy. Laboratory tests revealed Grade 3 hepatic dysfunction, and imaging showed accumulation of ascitic fluid. In the absence of infection or thrombosis, a diagnosis of trabectedin-induced liver injury with ascites was made. Supportive care, including hepatoprotective therapy, led to clinical improvement and resolution of the ascites. DISCUSSION: Hepatotoxicity is a recognized adverse effect of trabectedin, with proposed mechanisms including direct hepatocellular injury and cytokine-mediated damage. Peritonitis-like symptoms may arise from ascites secondary to hepatic dysfunction. In this case, hepatic dysfunction due to trabectedin may be the trigger for ascites presenting as a peritonitis-like manifestation. CONCLUSIONS: This case highlights the importance of vigilant monitoring during trabectedin therapy. Early recognition and management of liver injury and ascites presenting as a peritonitis-like manifestation are crucial. Further research is warranted to elucidate the mechanisms and risk factors associated with these toxicities.