Successful treatment of hepatic encephalopathy in a patient with acute lymphoblastic leukemia.
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.
Dada
Reyad
R
Medizinische Klinik IV, Universitatsklinikum Aachen, RWTH Aachen University, Aachen, Germany. rdada@ukaachen.de
Wilop
Stefan
S
Jost
Edgar
E
Galm
Oliver
O
Gassler
Nikolaus
N
Osieka
Rainhardt
R
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
D014750:Vincristine; D000641:Ammonia; D003907:Dexamethasone; D003520:Cyclophosphamide; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D001663:Bilirubin; D015255:Idarubicin