Fulminant Hepatic Failure due to Primary Hepatic Lymphoma: a Case Report
A 47-year old man was referred with a history of fever and jaundice for two months. The fever (oral temperature = 38.5°C without chills) and jaundice persisted despite the fact that two weeks ago, he had undergone cholecystectomy in another center for cholelithiasis. The patient was admitted to our center and a full work-up for sepsis was performed, including blood and urine cultures and chest radiography. Laboratory studies revealed abnormal liver enzymes (ALT=80; AST=60; ALP=1,100) and abnormal liver function tests (PT=18”; aPTT=40”; Hb=11; MCV=90; WBC=12,000; Plt=121,000). Serologic evaluations for brucellosis, leishmaniasis, borreliosis, and bone marrow aspiration and biopsy all returned normal. Chest and abdominal CT scans were normal (no mass lesion or lymphadenopathy), except for mild hepatomegaly (). Magnetic resonance cholangiopancreatography was also performed, yielding a normal result. A liver biopsy, performed after correction of prothrombin time with fresh frozen plasma, revealed diffuse large B-cell lymphoma (). Immunohistochemical assessments indicated the expression of CD20 and Bcl2 on blast, while CD10 was negative. The cells were negative for TdT, excluding a precursor lymphoid neoplasm. Few T-cells (CD5) were intermingled. There was no EBV-association (EBER in-situ hybridization). The proliferative capacity (Ki67) reached 60-70%.\nIn the meantime, the patient expired as a result of fulminant hepatic failure.