Acute lymphoblastic leukemia presenting as hepatitis in a young adult: An autopsy presentation

Abstract

Abstract Acute lymphoblastic leukemia (ALL) is a disease of children and is rarely found in adults where it is associated with poor prognosis. It typically presents with signs and symptoms of bone marrow failure. Hepatitis is rarely noted as a presenting feature in such cases and may cause delay in diagnosis and treatment if not suspected. A high index of suspicion for hematological malignancies is required if these patients are not responding to conventional management for hepatitis. We report an unusual systemic presentation of ALL in a 21-year-old previously healthy male. He initially presented with jaundice and was being managed conservatively, however, the absence of clinical recovery and the absence of any viral, immune, toxic, or metabolic cause of liver injury along with the presence of lymphocytosis in blood prompted us to consider a hematological malignancy. Hematological workup of the patient revealed a B-cell ALL and the patient was put on preinduction steroid therapy. The patient initially showed signs of improvement; however, 8 days posttherapy, he developed febrile neutropenia and went into septic shock. An autopsy was performed, which revealed infection by Klebsiella and Mucormycosis apart from leukemic infiltrates in multiple organs leading to multiorgan failure.