Cerebral hemorrhage during systemic chemotherapy with atezolizumab and bevacizumab for hepatocellular carcinoma

We report a case of cerebral hemorrhage during systemic chemotherapy with atezolizumab and bevacizumab for hepatocellular carcinoma. The patient was a male in seventies with a history of alcoholic cirrhosis. The patient also took dabigadran for paroxysmal atrial fibrillation. The lesion was 100 × 95 × 75 mm in size with tumor thrombus in the P8 branch of the portal vein. Since the indocyanine green retention rate at 15 minutes was 19.4%, systemic chemotherapy with atezolizumab and bevacizumab was performed. On day 29, the patient suddenly got right-sided hemianopia. Computed tomography showed hemorrhage in the left occipital lobe. Magnetic resonance imaging did not show any tumor lesions or vascular malformations. The hemorrhage gradually improved and chemotherapy was restarted with atezolizumab alone. No recurrent cerebral hemorrhage has been observed so far.