Phenotype of acute liver failure in inapparent small cell lung cancer
Xénia Faktorová1, Terézia Staškovanová1, Katarína Bilíková1, Richard Hokša2, Tomáš Tvrdík3, Zuzana Ďurkovičová1, Mária Szántová1
1 III. Interná klinika LF UK a UN Bratislava, Slovenská republika
2 Ústav patologickej anatómie, LF UK a UN Bratislava, Slovenská republika
3 I. rádiologická klinika LF UK, SZU a UN Bratislava, Slovenská republika
Acute liver failure is defined by the manifestation of liver failure from 7th to 21st day in a previously healthy liver. The most frequent causes are viral hepatitis B, A, E, drug or toxin-induced hepatotoxicity (Amanita phalloides), rarely Wilson’s disease, autoimmune hepatitis, HELLP (hemolysis, elevated liver enzymes, low platelets) syndrome, or vascular causes (Budd-Chiari syndrome, hypoxic hepatitis). We present a 71-year- -old female patient with metabolic syndrome admitted to hospital with cholestasis, progression of weakness, abdominal pain, and breathlessness. Because of suspected pleuropneumonia, the treatment with ceftriaxone/metronidazole was initiated. Due to cholestasis progression and suspicion of drug-induced liver toxicity, the treatment was stopped on 5th day. Imaging methods (ultrasonography, CT, magnetic resonance imaging) found multiple small liver lesions, suspected metastatic involvement, which was not confirmed by positron emission tomography – computed tomography. Due to the rapid progression of the patient’s condition with the onset of icterus, ascites, encephalopathy, a liver biopsy was not done. The patient died on the 17th day of hospitalization. The primary tumour was not detected during her life, and not by pathological section. The diffuse metastasis of small cell lung cancer (SCLC) in the liver was found by histological post mortem examination. The case report suggests high invasiveness of SCLC with a possibility of unusual manifestation in a form of acute hepatic failure.
Keywordsacute liver failure, small cell lung cancer, hepatotoxicity, diffuse metastasis
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