QJM Advance Access published online on September 23, 2008
QJM, doi:10.1093/qjmed/hcn121
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Haematological malignancies presenting with acute liver injury: a single-centre experience
1Liver Unit, Queen Elizabeth Hospital, Birmingham 2Department of Gastroenterology, University Hospital Coventry and Warwickshire, Coventry, UK 3Department of Gastroenterology, Duke University, Durham, NC, USA 4Department of Haematology 5Department of Pathology, Queen Elizabeth Hospital, Birmingham, UK
Address correspondence to S. Shetty, Queen Elizabeth Liver Transplant Unit, 3rd Floor Nuffield House, University Hospitals Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, UK. email: S.Shetty{at}bham.ac.uk
Received 14 April 2008 and in revised form 27 August 2008
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Abstract |
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Introduction: Early recognition and identification of the underlying cause of acute liver injury (ALI) is crucial in instituting medical treatment and assessing the need for liver transplantation. Haematological malignancies have been reported to present as ALI with progression to acute liver failure but experience is limited.
Aim: Review our experience of ALI secondary to haematological malignancies.
Patients and methods: Patients admitted to the liver unit with ALI secondary to a haematological malignancy between 1996 and 2006 were identified. A retrospective review was made of their case notes and our database.
Results: Of the 752 cases of ALI, six cases of ALI secondary to haematological malignancy were identified. Common features were a prodromal illness (median duration of 5 weeks; range 2–6 weeks) and jaundice (median bilirubin 208 µmol/l; range 112–238 µmol/l). The majority of patients (5/6) had hepatomegaly. Liver biopsy was performed in two patients and confirmed the diagnosis in both cases. In other cases, the diagnosis was made following lymph node biopsy (1), bone marrow examination (2) or from post-mortem examination (1). Median time from jaundice to encephalopathy was 12 days; range 1–22 days. A single patient underwent liver transplantation but died in the immediate post-operative period. All patients died soon after admission with a median survival of 8 days (range 3–26 days).
Conclusion: Haematological malignancy should be considered in ALI patients presenting with a prodromal illness, jaundice and hepatomegaly. Biopsy is essential to confirm the diagnosis but the benefit of definitive therapy such as chemotherapy and/or transplantation in this setting is unclear and survival is poor.