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

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.