Clinical features of non-Hodgkins lymphoma presenting with acute liver failure: a report of five cases and review of published experience.

Hematological malignancies frequently affect the liver, but typically do not result in hepatic dysfunction and rarely present with advanced hepatic involvement. We report five patients who presented with advanced hepatic involvement and were found to have a high-grade lymphoma infiltrating the liver. Despite early diagnosis and initiation of therapy, all five patients deteriorated rapidly and died shortly after the onset of liver failure. Several similar cases have been reported. They share common clinical features, including hepatomegaly, lactic acidosis, and death shortly after the onset of symptoms. Non-Hodgkins lymphoma is a common malignancy, which is increasing in incidence. Non-Hodgkins lymphoma is not commonly entertained as an etiology of advanced liver failure and is likely underrecognized. In cases of acute advanced liver failure without an apparent etiology, especially if associated with hepatomegaly and lactic acidosis, lymphoma should be considered because of its poor prognosis and potential for treatment if recognized early. Liver biopsy is an invaluable tool that provides an early diagnosis while excluding other potential etiologies for acute advanced liver failure.