title: Acute liver failure due to hepatic involvement by hematologic malignancy.
abstract: Infiltration of the liver by secondary malignancies is a rare cause of acute liver failure. Acute liver failure caused by malignant infiltration is associated with almost 100% mortality and is typically diagnosed postmortem. Richter's transformation is a well-recognized complication of chronic lymphocytic leukemia. This transformation is the progression of chronic lymphocytic leukemia to a high-grade lymphoma. We describe the case of a 64-year-old man with a history of chronic lymphocytic leukemia who presented with acute liver failure. Liver biopsy revealed hepatic infiltration by a high-grade lymphoma. The patient responded to chemotherapy with normalization of hepatic function and remained disease-free after eight months. This case represents the first report of Richter's transformation presenting as acute liver failure. It also represents the fourth reported case of a patient with acute liver failure secondary to involvement by a hematopoietic malignancy that was successfully recognized and treated.
authors.affiliation: Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Shehab
authors.forename: M S
authors.initials: MS
authors.lastname: Kaminski
authors.forename: A S
authors.initials: AS
authors.lastname: Lok
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology*; D008099:Liver / Q000473:pathology*; D017114:Liver Failure, Acute / Q000209:etiology*; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone