title: Successful treatment of hepatic encephalopathy in a patient with acute lymphoblastic leukemia.
abstract: Infiltration of the liver with consecutive severe dysfunction is rarely seen in adult acute lymphoblastic leukemia (ALL). We describe a case of a 32-year-old woman with severe icterus, thrombocytopenia, neutropenia and hepatosplenomegaly. ALL was diagnosed. One day after admission, she developed hepatic encephalopathy with ammonia concentrations in plasma >100 micromol/l. Hepatic infiltration was presumed and chemotherapy was initiated immediately which led to resolution of hepatic encephalopathy and complete hematological remission. Clinicians should be aware of unusual presentations of ALL and difficulties for the application of chemotherapy in patients with liver failure.
authors.affiliation: Medizinische Klinik IV, Universitatsklinikum Aachen, RWTH Aachen University, Aachen, Germany. rdada@ukaachen.de
authors.forename: Reyad
authors.initials: R
authors.lastname: Dada
authors.forename: Stefan
authors.initials: S
authors.lastname: Wilop
authors.forename: Edgar
authors.initials: E
authors.lastname: Jost
authors.forename: Oliver
authors.initials: O
authors.lastname: Galm
authors.forename: Nikolaus
authors.initials: N
authors.lastname: Gassler
authors.forename: Rainhardt
authors.initials: R
authors.lastname: Osieka
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000641:Ammonia / Q000097:blood; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006501:Hepatic Encephalopathy / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy*; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014750:Vincristine; D000641:Ammonia; D003907:Dexamethasone; D003520:Cyclophosphamide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin; D015255:Idarubicin