Case Report
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World J Gastroenterol. Nov 28, 2014; 20(44): 16774-16778
Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16774
Case report of acute-on-chronic liver failure secondary to diffuse large B-cell lymphoma
Yahuza Siba, Kenechukwu Obiokoye, Richard Ferstenberg, James Robilotti, Joan Culpepper-Morgan
Yahuza Siba, Kenechukwu Obiokoye, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States
Richard Ferstenberg, James Robilotti, Joan Culpepper-Morgan, Division of Gastroenterology, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, New York, NY 10037, United States
Author contributions: Siba Y and Obiokoye K are the residents who managed the case as well as drafting the article; Ferstenberg R and Robilotti J helped write and edit the manuscript; Culpepper-Morgan J supervised, proof-read and made all the necessary corrections required; all the authors reviewed and agreed on the final manuscript.
Correspondence to: Yahuza Siba, MD, Department of Medicine, Columbia University Medical Center, Harlem Hospital Center, 506 Lenox Avenue, New York, NY 10037, United States. sy2394@columbia.edu
Telephone: +1-212-9392296 Fax: +1-212-9392263
Received: May 31, 2014
Revised: August 4, 2014
Accepted: September 29, 2014
Published online: November 28, 2014
Processing time: 185 Days and 2.7 Hours
Abstract

Acute liver failure is a rare presentation of hematologic malignancy. Acute on chronic liver failure (ACLF) is a newly recognized clinical entity that describes acute hepatic decompensation in persons with preexisting liver disease. Diffuse large B-cell lymphoma (DLBCL) is an aggressive non-Hodgkin’s lymphoma (NHL) with increasing incidence in older males, females and blacks. However, it has not yet been reported, to present with acute liver failure in patients with preexisting chronic liver disease due to human immunodeficiency virus (HIV)/hepatitis C virus (HCV) co-infection. We describe a case of ACLF as the presenting manifestation of DLBCL in an elderly black man with HIV/HCV co-infection and prior Hodgkin’s disease in remission for three years. The rapidly fatal outcome of this disease is highlighted as is the distinction of ACLF from decompensated cirrhosis. Due to the increased prevalence of HIV/HCV co-infection in the African American 1945 to 1965 birth cohort and the fact that both are risk factors for chronic liver disease and NHL we postulate that the incidence of NHL presenting as ACLF may increase.

Keywords: Diffuse large B-cell lymphoma; Acute-on-chronic liver failure; Human immunodeficiency virus; Hepatitis C virus; Hodgkin’s disease; Fatal outcome

Core tip: Recognition of acute on chronic liver failure (ACLF) is vital because it may be rapidly fatal. However, many patients have underlying silent liver disease, especially, hepatitis C virus (HCV) cirrhosis. Diffuse large B-cell lymphoma is an aggressive lymphoma which is beginning to occur more frequently in the same race and birth cohort as HCV/human immunodeficiency virus related liver disease. Early recognition and potential treatment of this rapidly fatal lymphoma depends on a high index of suspicion. Due to the shared demographics the incidence of non-Hodgkin’s lymphoma presenting as ACLF is likely to increase.