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• W2922144546 abstract "Primary hepatic lymphoma (PHL) is a rare malignancy localized to the liver but is generally responsive to standard chemoimmunotherapy and in some instances associated with prolonged disease-free survival. We present a fatal case of acute liver failure (ALF) and severe lactic acidosis associated with extensive involvement of the liver by a diffuse large B-cell lymphoma (DLBCL). A 68-year old HIV-negative male initially presented with severe fatigue, weakness, and weight loss over a month. Initial laboratory tests were significant for a pH of 7.21, INR of 2.7, total bilirubin of 7.4 mg/dL, AST of 1454 IU/L, ALT of 901 IU/L, ammonia of 29 umol/L, and lactic acid of 16.4 mmol/L. Workup for viral, autoimmune, and acetaminophen-induced liver injury were unrevealing and abdominal CT, MRI, and duplex ultrasound showed no apparent liver masses. A liver biopsy was performed given the unclear etiology of severe acute liver injury and worsening severe lactic acidosis. Over a span of 48 hours with adequate hemodynamics, the patient became obtunded and had further decompensation to acute liver failure (ALF) with an INR of 3.9, AST of 2089 IU/L, ALT of 827 IU/L, and total bilirubin 11.5 mg/d. While on renal replacement therapy, lactic acid levels continued to rise to 33.5 mmol/L and the patient was transitioned to comfort measures per family wishes. Pathological interpretation of his liver biopsy showed a highly infiltrative DLBCL, activated B cell-like subtype. Given the lack of significant lymphadenopathy on imaging and clinical exam and no other suspected sites of extra-nodal disease, PHL was suspected. We hypothesize that severe lactic acidosis in PHL may be a marker of aggressive cancer biology consistent with the patient's molecular subtype and a Ki67 level near 100%. We discuss possible mechanisms of ALF and extreme lactic acid production in relation to PHL based on recent discoveries elucidating abnormal cancer metabolic pathways. Our report highlights that although rare, PHL should be considered in the differential of unexplained ALF and lactic acidosis even without supporting imaging or other clinical findings because early treatment for this potentially curable disease may be essential in preventing early fatalities.2176 Figure 1. B cell lineage primary hepatic lymphoma. A. Liver core biopsies were obtained demonstrating high-grade lymphoma infiltrating the liver parenchyma forming nodules of various sizes. Background liver tissue showed sinusoidal dilation, congestion, and parenchymal destruction. B. Ki-67 staining approached 95% positivity." @default.
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• W2922144546 date "2018-10-01" @default.
• W2922144546 modified "2023-10-16" @default.
• W2922144546 title "A Fatal Case of Severe Lactic Acidosis and Acute Liver Failure in a Patient with Primary Hepatic Lymphoma" @default.
• W2922144546 doi "https://doi.org/10.14309/00000434-201810001-02175" @default.
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