Abstract
BackgroundMalignant liver infiltration is an uncommon cause of acute liver failure (ALF) and has rarely been reported.Case PresentationWe present a patient with progressive jaundice and dissociation of bilirubin and aminotransferases, who had no history of relevant liver diseases or tumor except the use of Chinese traditional drugs for a cold. An abdominal computed tomography (CT) scan showed ascites without hepatic focal lesions. Laboratory studies revealed no evidence of hepatitis or underlying autoimmune disorders. Following 8 days of conservative management ALF rapidly worsened. Contrast-enhanced CT revealed diffuse regenerative nodules in the liver. The patient underwent liver biopsy, which demonstrated that the liver was infiltrated by pulmonary neuroendocrine tumor classified as small cell lung cancer. The patient died 13 days after diagnosis.Discussion and ConclusionsThis case represents a rare cause of ALF induced by pulmonary neuroendocrine tumor of small cell type and illustrates the importance of prompt biopsy in an unknown cause of ALF.
Highlights
Acute liver failure (ALF) is defined as acute liver dysfunction manifesting as encephalopathy and coagulopathy [INR] ≥ 1.5) of less than 26 weeks duration, without preexisting liver disease [1]
We report a case of acute liver failure (ALF) associated with malignant infiltration of small cell neuroendocrine carcinoma without a history of primary malignant tumors
We report a rare case of ALF due to infiltration by a pulmonary neuroendocrine tumor (PNET)
Summary
Acute liver failure (ALF) is defined as acute liver dysfunction manifesting as encephalopathy and coagulopathy [INR (international normalized ratio)] ≥ 1.5) of less than 26 weeks duration, without preexisting liver disease [1]. Of the known etiologies of ALF in adults, drug toxicity (50%), viral hepatitis (9%), and autoimmune hepatitis (7%) are most common [2, 3]. The liver is a common target for metastasis, a significant number of patients are asymptomatic with mildly abnormal liver function tests. There are very few reports of ALF resulting from malignancy (0.44– 1.4%) [3, 4]. Most cases have a poor prognosis with liver failure occurring within several days [2]. Liver biopsy in unexplained cases must be carried out, as the findings can provide information on appropriate treatment. We report a case of ALF associated with malignant infiltration of small cell neuroendocrine carcinoma without a history of primary malignant tumors. We evaluated the clinical and laboratory data, treatment and prognosis
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