Malignancy can Present as Acute Liver Failure - A Case Report of B-Cell Lymphoma with Acute Liver Failure as its First Presentation.

Malignant infiltration of the liver is a rare cause of acute liver failure and is associated with an exceedingly high mortality rate. We describe the case of an elderly woman presenting with fulminant hepatitis and simultaneous type B lactic acidosis, with near-normal imaging findings, who was later demonstrated to have non-Hodgkin lymphoma. The presence of acute liver failure, hepatomegaly, markedly elevated lactate dehydrogenase and/or lactic acidosis should raise suspicion for lymphoma infiltration of the liver and prompt liver biopsy early in the course of disease. We hope to raise awareness for this uncommon and elusive presentation of lymphoma, in the hope that it will help achieve earlier diagnoses and improvements in patient survival. LEARNING POINTS: Lymphoma presenting as fulminant hepatitis is rare and frequently fatal.Malignant infiltration of the liver should be suspected in cases of acute liver failure, particularly when no clear aetiology is present, and liver biopsy should be performed promptly.The internist should be aware of lymphoma as a potential cause of type B, non-hypoxemic lactic acidosis.