Acute liver failure associated with diffuse large B-cell lymphoma: an autopsy case report

Abstract

Acute liver failure (ALF) associated with malignant infiltration of the liver is rare and its pathological and radiologic features remain poorly described. An 87-year-old man was admitted to our hospital for anorexia for several days, high-grade fever from the previous day, and liver dysfunction but suddenly died on day 3 of hospitalization due to ventricular fibrillation. The patient was diagnosed at autopsy with malignant diffuse large B-cell lymphoma. To the best of our knowledge, this report represents a valuable addition to the ALF literature describing a case of ALF associated with diffuse large B-cell lymphoma diagnosed at autopsy.

An Elusive Diagnosis: Diffuse Large B-Cell Lymphoma Masquerading as Acute Liver Failure with Persistent Lactic Acidosis

“…In those cases, the prognosis has been generally poor, with high rates of in-hospital mortality. Three cases were diagnosed at autopsy [ 11 ]. A summary of previously documented cases of acute liver failure due to infiltration of the liver by non-Hodgkin lymphoma is shown in Table 2 .…”

“…In a study by Rich et al, liver biopsy was found to be a hallmark in the early diagnosis of such patients [ 4 ], but bone marrow biopsy and gastric biopsy can also help with the diagnosis. Early diagnosis of DLBCL provides the chance for proper treatment of patients with chemotherapy, and this has proved to decrease the mortality rate [ 11 ]. However, liver biopsy should be carefully considered in patients with ALF due to the risk of complications that can be exacerbated by coagulopathy and thrombocytopenia.…”

A Rare Case of Acute Liver Failure Secondary to Miliary Liver Metastasis

“…Acute liver failure (ALF) is a rare but life-threatening condition that causes multiorgan effects [ 1 ]. Although the liver is the most frequent site for metastasis (36%), ALF from malignant infiltration is extremely rare [ 4 ].…”

“…Acute liver failure (ALF), also known as fulminant hepatic failure, is a clinical phenomenon characterized by severe acute liver injury with encephalopathy and impaired synthetic function (international normalized ratio (INR) >1.5) in a patient without the pre-existing liver disease [ 1 ]. ALF has a variety of causes that include both primary causes as well as secondary ones.…”

“…Encephalopathy, cerebral edema, sepsis, renal failure, and respiratory failure are some possible complications of liver failure [ 3 ]. There were some instances that liver imaging studies that were nondiagnostic and the malignant liver infiltration was confirmed at postmortem [ 1 ]. A proper diagnosis by liver biopsy is essential but may fail to recognize the primary site of origin as in our case.…”