Malignant psoas syndrome (MPS) is caused by malignant infiltration of the psoas muscle and adjacent nerves. Patients with MPS have a combination of pain, both neuropathic and nociceptive, which is often refractory to conventional analgesic therapy. We report the case of a 53-year-old female patient with left MPS caused by the growth of pelvic lymph node metastases from uterine carcinosarcoma. Palliative radiation therapy (RT) to the regional lymph nodes was planned; however, we could not start it because the patient was unable to extend her left hip and stay at rest in the supine position during the RT. We administered epidural analgesia with short-acting local anesthetics 30 min before RT. She could extend her hips despite remaining of pain. We then administered single-shot epidural analgesia just before every RT and were able to perform RT as scheduled. Multimodal approach is needed to manage MPS. In this case, combined oral treatment and epidural analgesia was an effective analgesic therapy for relief of pain due to MPS. Here we report the effective pain management of MPS with repeated single-shot epidural block for palliative RT.

Introduction: There are many reports about hepatotoxicity associated with acute overdose or long-term use of acetaminophen, but few reports of that associated with therapeutic doses. We present a case of acute liver failure with hepatic coma caused by therapeutic doses of intravenous acetaminophen for cancer pain relief in palliative care setting. Case: The patient was a 56-year-old woman with stage IV lung cancer and normal liver function. She was admitted to the hospital because of anorexia and cancer pain. She received 1g intravenous acetaminophen every six hours for analgesia of pleural and rib metastasis. The patient’s AST/ALT levels were elevated at 3104/1212 IU/L, while she was receiving 11 doses of intravenous acetaminophen. She was treated with oral N-acetylcysteine, hemadsorption and plasma exchange therapy. Liver function returned to normal soon. Discussion: Therapeutic doses of intravenous acetaminophen is generally used in palliative care setting, and hepatic failure may occur due to glutathione depletion in patients with cancer anorexia. The potential hazard of rare but serious complications should always be kept in mind even with therapeutic doses.