Korean J Med.  2016 Jan;90(1):32-36. 10.3904/kjm.2016.90.1.32.

An Aggressive Natural Killer Cell Lymphoma Presenting as Acute Liver Failure with Ascites

• Lee JH
• Oh TH
• Park JY
• Jeon TJ
• Baek SS
• Ha TH
• Park SE

• KMID: 2268887
• DOI: http://doi.org/10.3904/kjm.2016.90.1.32

Abstract

Acute liver failure (ALF) is a medical emergency triggering an urgent need for liver transplantation. The most common causes of ALF are drug- and virus-associated hepatitis, but hematological malignancies such as an aggressive natural killer cell lymphoma (ANKL) can uncommonly cause ALF. A 50 year-old male presented with ascites, jaundice, and encephalopathy. The ascitic fluid had a serum-ascites albumin gradient of 0.3 g/L, and contained atypical lymphocytes, which were positive for CD3. Computed tomography revealed mild hepatomegaly and multiple nodules in both lobes of the liver. A liver biopsy showed that the liver parenchyma had been infiltrated by malignant lymphoid cells, and exhibited marked sinusoidal dilatation. Immunohistochemically, the lymphoid cells were positive for CD3, CD56, and Epstein-Barr virus-encoded small RNA. The patient was diagnosed with ANKL causing ALF, and died on hospital day 12. This case shows that infiltration of the liver with ANKL can (rarely) cause ALF.

Keyword

Liver failure; Acute; Lymphoma; Extranodal NK-T-cell; Ascites

MeSH Terms

Ascites*
Ascitic Fluid
Biopsy
Dilatation
Emergencies
Hematologic Neoplasms
Hepatitis
Hepatomegaly
Humans
Jaundice
Killer Cells, Natural*
Liver
Liver Failure
Liver Failure, Acute*
Liver Transplantation
Lymphocytes
Lymphoma*
Male
RNA
RNA