Published online Nov 28, 2014. doi: 10.3748/wjg.v20.i44.16774
Revised: August 4, 2014
Accepted: September 29, 2014
Published online: November 28, 2014
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.
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.