Amit K. Agarwal, MD1, Joseph Yoo, MD1, Dina Halegoua-DeMarzio, MD2
1Thomas Jefferson University Hospital, Philadelphia, PA; 2Thomas Jefferson University, Philadelphia, PA
Introduction: The liver is a common site of metastasis in small cell lung carcinoma (SCLC), with 20% of cases metastasizing to the liver. However, most liver metastases are discovered at time of autopsy and not at initial diagnosis. Given the scarcity of literature regarding sub-acute liver failure as the presenting sign of metastatic SCLC, this case explores a patient who presented with sub-acute liver failure secondary to diffuse, infiltrative metastatic SCLC.
Case Description/Methods: A 54 year old Caucasian male with no significant past medical history presented with jaundice and ascites. He denied any history of alcohol consumption, any personal or family history of liver disease, and consumption of any supplements or over the counter medications. Physical examination was notable for marked abdominal distension with shifting dullness, grade I hepatic encephalopathy, and mild asterixis. He did not have findings of chronic liver disease. Labs were significant for a creatinine of 1.1, sodium of 128, total bilirubin of 8.9, ALT 85, AST 227, alkaline phosphatase 153, and an INR of 3.03, with a MELD-Na score of 32. Laboratory workup was negative for causes of liver failure, including infectious and autoimmune etiologies. A triple phase contrast enhanced CT abdomen showed multiple hypodense lesions too small to characterize, without any large enhancing liver mass seen. Given the patient’s high MELD-Na score and an initial concern for liver failure, the patient was transferred to our institution for liver transplant. To determine the etiology of his suspected cirrhosis after negative serologic workup, a transjugular liver biopsy was obtained. Pathology results were not consistent with cirrhosis, and instead revealed diffuse, infiltrative metastatic small cell carcinoma from a suspected primary lung cancer in the setting of a 1.8cm lung lesion later seen on CT chest. He was subsequently removed from liver transplant consideration. The patient unfortunately expired due to liver failure.
Discussion: This is a case of a patient who presented with sub-acute liver failure due to metastatic small cell carcinoma. Liver failure is a rare presentation of metastatic disease but has been reported in malignancies such as metastatic breast cancer. While SCLC metastasis to the liver is common, it has only rarely been described to cause sub-acute liver failure.
Citation: Amit K. Agarwal, MD; Joseph Yoo, MD; Dina Halegoua-DeMarzio, MD. P2509 - SUB-ACUTE LIVER FAILURE AS THE INITIAL MANIFESTATION OF METASTATIC SMALL CELL LUNG CANCER. Program No. P2509. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.