2300 Chronic Lymphocytic Leukemia of the Liver: A Rare Cause of Elevated Liver Function Tests

Abstract

INTRODUCTION: Chronic lymphocytic leukemia is a lymphocytic proliferative malignancy that can infiltrate multiple different organs. It is one of the most common forms of leukemia in the adult population. CLL affecting the liver is historically rare, however since recent it has been becoming more prevalent due to certain advancements in chemotherapy. With metastatic CLL becoming more prevalent, we should focus expansion of research to this subset of patients. CASE DESCRIPTION/METHODS: A 76-year-old male with a past medical history of CLL 13q14 mutation+ and a recent diagnosis of renal insufficiency was evaluated by his Gastroenterologist for elevated liver enzymes. He was found to have an AST of 112 and an ALT of 348. His ferritin was also elevated to 953 with a transferrin saturation of 27%. He was referred to a Hepatologist for a more in-depth workup, which revealed worsening lymphadenopathy on CT scan along with worsening hepatomegaly and splenomegaly on abdominal ultrasound. Blood work was ordered for evaluation of infectious, inflammatory and autoimmune causes of his elevated liver enzymes. The patient’s blood work showed a negative ANA/SMA/AMA, a negative HAV/HBV/HCV. The patient underwent percutaneous liver biopsy for further evaluation. The biopsy showed involvement of his liver with dense lymphoid infiltrate of the portal tracts, consistent with chronic lymphocytic leukemia. The pathology also resulted showing the liver parenchyma showed the same biomarkers as the patients serum studies. The positivity of CD5, CD23 and PAX5 was consistent with the previous serum studies. The patient was initiated on Imbruvica, which provided improvement in his liver function tests. He continues to follow with Oncology for continued treatment on Imbruvica. DISCUSSION: The increased prevalence of liver dysfunction brings up new conversations in CLL treatment. Liver infiltration has not been studied as much as other organ systems and this limits our understanding of this chronic, debilitating disease process. There has been a documented shorter survival for patients diagnosed with liver infiltration of CLL, which limits our patient’s quality of life if we do not better grasp this potential complication of CLL.