Viral
hepatitis and toxins comprise most common causes of fulminate
hepatic failure that are often diagnosed with standard laboratory tests. Herein we discuss a rare, difficult to diagnosis etiology of
acute liver failure (ALF). A 62-year-old man presented with a two-week history of
fever and
fatigue. At four days before admission he became lethargic. His past medical and
drug histories were unremarkable. Physical examination revealed generalized
jaundice,
fever and
loss of consciousness. Laboratory tests showed elevated liver
transaminases with direct hyper-
bilirubinemia. Abdominal ultrasonography and CT scan showed hepatosplenomegaly and para-aortic abdominal
lymphadenopathy. A further work-up included liver biopsy. The histopathology and imunohistochemistry was compatible with
diffuse large B-cell lymphoma. He underwent high dose
glucocorticoid therapy but his condition deteriorated rapidly and he died eight days after admission. ALF as an initial manifestation of malignant hepatic infiltration is extremely rare yet should be considered in all patients with unknown
hepatic failure that are highly suspicious for
malignant neoplasm.