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Case report
Acute liver failure masquerading an occult malignancy
  1. Pooja Gogia1,
  2. Sotirios Doukas1,
  3. Marcus Porcelli2 and
  4. Tricia Gilbert3
  1. 1Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA
  2. 2Central Jersey Division of Regional Cancer Care Associates LLC, Somerset, New Jersey, USA
  3. 3Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
  1. Correspondence to Dr Pooja Gogia; poojagogia.dr{at}


Acute liver failure (ALF) is a rare initial presentation of metastatic liver disease and is associated with high fatality. Our case report describes acute hepatic decompensation from an occult pancreatic malignancy. A 64-year-old man presented with abdominal distension for 2 weeks associated with decreased appetite and a weight loss of 13.6 kg, over the past 8 months. Significant admission labs were serum creatinine: 6.15 mg/dL, serum bilirubin: 27 mg/dL, aspartate aminotransferase (AST): 316 u/L, alanine aminotransferase (ALT): 198 u/L and serum alkaline phosphatase: 2121 u/L. He was admitted to the medical intensive care unit and was started on dialysis for acute renal failure. MRI of the abdomen showed multiple masses in the liver concerning for metastatic disease, cystic lesions in the pancreatic body and ascites. He underwent paracentesis and ascitic fluid analysis was positive for adenocarcinoma. CA 19-9 was 17 828 u/mL. The patient’s condition gradually deteriorated, and he died of cardiac arrest.

  • cancer - see oncology
  • pancreatic cancer

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  • Contributors PG, MP and TG involved in conception, design and managing the patient. PG, SD, MP and TG involved in drafting the work and revising critically, and finally approved the manuscript to be published. All authors agreed to be accountable for all aspects of work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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