Acute liver failure secondary to hepatic infiltration: a single centre experience of 18 cases

Abstract

Background-Acute liver failure (ALF) secondary to malignant infiltration of the liver is rare and is diagnosed often only after death. Aims-To determine diagnostic factors and particular clinical patterns of illness. Methods-Review of case notes from all patients with ALF secondary to hepatic infiltration admitted to this unit over an 18 year period (1978)(1979)(1980)(1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995). Results-From a total of 4020 admissions, 18 patients were identified with ALF attributable to hepatic infiltration. Mean age was 40.7 years. Aetiology was nonHodgkin's lymphoma in nine patients, Hodgkin's disease in three, infiltrative metastatic carcinoma in four, and haemophagocytosis with no precipitant cause in two cases. Prodromal symptoms were non-specific, but occurred at least two to four weeks before onset of ALF, making the presence of such symptoms of value in diVerential diagnosis of the cause of ALF. Clinical examination and investigations were unhelpful in distinguishing these cases from more usual causes of ALF. Usually, the clinical course was of rapid deterioration and death from multiorgan failure, and only one patient survived. Diagnosis was made during life in 15 patients. Histology showed evidence of widespread hepatocellular necrosis, with diVuse infiltration by tumour cells rather than focal cellular aggregation. Conclusions-Only with accurate histological diagnosis from liver biopsy and institution of specific therapy early in the management of such patients will the best chance of recovery be achieved. In every case of ALF with prodromal symptoms or abnormal imaging, hepatic histology should be obtained by liver biopsy as soon as possible to diagnose infiltrative hepatic disease. (Gut 1998;42:576-580)

Amyloidosis presenting as acute liver failure: a case report

“…Amyloidosis and MM resulting in hepatic failure has previously been reported but remains quite rare [7,8]. Only a few case reports in the past few years have been able to successfully touch on the rarity of our patient's presentation of acute liver failure in the face of newly diagnosed amyloidosis and MM [12][13][14][15].…”

“…However, the development of acute liver failure is rare in patients with AL. In fact, the incidence of acute liver failure in patients with any infiltrating malignancy, such as MM, is less than 1% [7]. Here, we report an unusual case of hepatic amyloidosis presenting as acute liver decompensation resulting in death.…”

Acute Liver Failure Because of Chronic Lymphocytic Leukemia: Case Report and Review of the Literature

“…Liver failure caused by infiltration of lymphoma or leukemia is uncommon and usually associated with a poor prognosis [1][2][3] . Hodgkin and non-Hodgkin lymphomas, acute leukemias, and transformation of chronic leukemias to acute stages have all been associated with sporadic cases of acute liver failure [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] .…”

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“…The diagnosis of acute liver failure is made clinically on the basis of physical examination findings such as altered mental status and supportive laboratory results like prolonged prothrombin time [3]. The most commonly identified causes of acute liver failure include medications and idiosyncratic drug toxicity, initial presentation of autoimmune hepatitis and viral infections [4][5][6][7] also we should keep in mind other possibilities for example Eclampsia, Fatty liver of pregnancy, Hepatic ischemia, Malignant infiltration, Toxins and/or Wilson disease [4,[8][9][10].…”