title: Fulminant hepatic failure from primary hepatic lymphoma: successful treatment with orthotopic liver transplantation and chemotherapy.
abstract: Systemic lymphomas may involve the liver but rarely cause fulminant hepatic failure (FHF). Acute liver failure from primary hepatic lymphoma (PHL) is even less common with most patients succumbing to the sequelae of FHF before the correct diagnosis is made. We report a patient who underwent successful orthotopic liver transplant (OLT) and chemotherapy for FHF secondary to PHL. This previously-well male developed profound coagulopathy and encephalopathy 6 weeks after the onset of jaundice and fatigue. Workup failed to reveal the underlying cause of his liver failure and the patient soon required urgent OLT. Pathologic evaluation of his explanted liver revealed a malignant T-cell rich, large B-cell non-Hodgkin's lymphoma with widespread hepatocellular necrosis. The patient made an excellent clinical recovery and is undergoing CHOP-Rituxan chemotherapy. This scenario demonstrates that lymphoma should be considered in the differential diagnosis of FHF without clear etiology because of the potential for intervention with transplant and chemotherapy.
authors.affiliation: Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095-7054, USA. acameron@mednet.ucla.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Cameron
authors.forename: Jadwiga
authors.initials: J
authors.lastname: Truty
authors.forename: Jeff
authors.initials: J
authors.lastname: Truell
authors.forename: Charles
authors.initials: C
authors.lastname: Lassman
authors.forename: Michael A
authors.initials: MA
authors.lastname: Zimmerman
authors.forename: Burnett S
authors.initials: BS
authors.lastname: Kelly
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Farmer
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Hiatt
authors.forename: Rafik
authors.initials: R
authors.lastname: Ghobrial
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D003131:Combined Modality Therapy; D006801:Humans; D008099:Liver / Q000473:pathology; D017114:Liver Failure, Acute / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology; D016031:Liver Transplantation; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome