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- W2912997608 abstract "Introduction: Drug toxicity and viral hepatitis are the most common causes of ALF. A rarely reported cause of ALF is malignant infiltration of the liver due to either a solid organ tumor or hematological malignancy. Here we present a case of an ALF in a breast cancer patient. Case: 80 year old woman diagnosed with invasive ductal carcinoma of the breast, estrogen receptor positive, progesterone receptor negative & HER2 negative and was started on anastrozole in view of her advanced age and comorbidities. She was then admitted to the hospital for altered mental status, fatigue, and abdominal pain. Initial laboratory assessment showed derangement of liver test showing alkaline phosphatase (ALP): 517, aspartate aminotransferase (AST): 687, alanine transaminase (ALT):171, total bilirubin 5.2, INR 1.9. Hepatitis panel and autoimmune panel were unremarkable. Abdominal ultrasound revealed heterogeneous nodular liver without biliary ductal dilatation and mild ascites. No focal hepatic lesion was noted. Patient's liver function continued to deteriorate despite avoidance of hepatotoxic medications including anastrozole. Laboratory findings on hospital day 10 showed ALP: 406, AST: 1099, ALT: 247, INR 4.4. Provisional diagnosis of pseudocirrhosis was made in the setting of breast cancer without history of chronic liver disease. Liver biopsy was not pursued for the lack of definite therapeutic benefit. Patient was discharged to hospice in view of poor prognosis. Patient died of multiorgan failure due to fulminant hepatic failure.Table: Table. Laboratory valuesDiscussion: Clinically severe hepatic dysfunction with coagulopathy and encephalopathy because of metastatic tumor involvement is rare. Liver metastases usually present as radiographically detectable lesions that do not significantly compromise liver function. Rarely, metastatic carcinoma can diffusely infiltrate hepatic sinusoids, a pattern of metastasis that may be missed on imaging studies, and can result in liver failure. ‘Pseudocirrhosis' refers to morphological changes of the liver that mimic cirrhosis without histological changes caused by hepatic metastasis in setting of chemotherapy. The common malignancies are breast cancer, lymphoma or leukemia, colon cancer and others are rare. Prognosis is poor with after hospitalization mortality rate reported between 90-100%. The diagnosis of ALF secondary to malignancy can be challenging and may elude clinicians initially, particularly in patients with no previous cancer history." @default.
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- W2912997608 date "2017-10-01" @default.
- W2912997608 modified "2023-09-26" @default.
- W2912997608 title "Pseudocirrhosis: A Cause of Acute Liver Failure (ALF)" @default.
- W2912997608 doi "https://doi.org/10.14309/00000434-201710001-02298" @default.
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