title: Case report of acute-on-chronic liver failure secondary to diffuse large B-cell lymphoma.
abstract: Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure (ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting liver disease. Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin's lymphoma (NHL) with increasing incidence in older males, females and blacks. However, it has not yet been reported, to present with acute liver failure in patients with preexisting chronic liver disease due to human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection. We describe a case of ACLF as the presenting manifestation of DLBCL in an elderly black man with HIV/HCV co-infection and prior Hodgkin's disease in remission for three years. The rapidly fatal outcome of this disease is highlighted as is the distinction of ACLF from decompensated cirrhosis. Due to the increased prevalence of HIV/HCV co-infection in the African American 1945 to 1965 birth cohort and the fact that both are risk factors for chronic liver disease and NHL we postulate that the incidence of NHL presenting as ACLF may increase.
authors.affiliation: Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States.
authors.forename: Yahuza
authors.initials: Y
authors.lastname: Siba
authors.affiliation: Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States.
authors.forename: Kenechukwu
authors.initials: K
authors.lastname: Obiokoye
authors.affiliation: Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Ferstenberg
authors.affiliation: Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States.
authors.forename: James
authors.initials: J
authors.lastname: Robilotti
authors.affiliation: Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States.
authors.forename: Joan
authors.initials: J
authors.lastname: Culpepper-Morgan
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000208:ethnology / Q000209:etiology* / Q000628:therapy; D001741:Black or African American; D000368:Aged; D060085:Coinfection; D018450:Disease Progression; D017809:Fatal Outcome; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000208:ethnology; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis / Q000208:ethnology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000150:complications* / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy; D008297:Male; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Acute-on-chronic liver failure; Diffuse large B-cell lymphoma; Fatal outcome; Hepatitis C virus; Hodgkin’s disease; Human immunodeficiency virus