title: Acute lymphoblastic leukemia presenting as acute hepatic failure in childhood.
abstract: We report a 7-year old white girl who was admitted because of acute severe hepatic failure. Her complete blood count revealed pancytopenia and a bone marrow aspiration was consistent with acute lymphoblastic leukemia (ALL). Blasts cells were positive for cytoplasmic CD3 and cell surface T-associated markers. Viral, metabolic, immune and toxic causes for hepatic failure were ruled out. Treatment pre-phase with prednisone was started and liver function tests clearly improved after one-week therapy. However, due to her hepatic insufficiency, daily etoposide was administered orally during 15 days. On day 33 complete remission was achieved and hepatic function was normal, except for an increase in the bilirubin level which normalized on day 72. She received our current treatment for intermediate risk ALL and is still receiving continuation phase therapy, currently, with normal liver function and good tolerance to chemotherapy + 8 months after achieving complete remission.
authors.affiliation: Hematology/Oncology Department, Hospital de Pediatría SAMIC Prof Dr Juan P. Garrahan, Buenos Aires, Argentina. mfelice@dd.com.ar
authors.forename: M S
authors.initials: MS
authors.lastname: Felice
authors.forename: E
authors.initials: E
authors.lastname: Hammermuller
authors.forename: M T
authors.initials: MT
authors.lastname: De Dávila
authors.forename: M E
authors.initials: ME
authors.lastname: Ciocca
authors.forename: L E
authors.initials: LE
authors.lastname: Fraquelli
authors.forename: A M
authors.initials: AM
authors.lastname: Lorusso
authors.forename: F
authors.initials: F
authors.lastname: Sackmann-Muriel
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage; D002648:Child; D003937:Diagnosis, Differential; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D011241:Prednisone / Q000008:administration & dosage
chemical_list: D000893:Anti-Inflammatory Agents; D000972:Antineoplastic Agents, Phytogenic; D005047:Etoposide; D011241:Prednisone