PT  - JOURNAL ARTICLE
AU  - Pooja Gogia
AU  - Sotirios Doukas
AU  - Marcus Porcelli
AU  - Tricia Gilbert
TI  - Acute liver failure masquerading an occult malignancy
AID  - 10.1136/bcr-2020-235935
DP  - 2020 Sep 01
TA  - BMJ Case Reports
PG  - e235935
VI  - 13
IP  - 9
4099  - http://casereports.bmj.com/content/13/9/e235935.short
4100  - http://casereports.bmj.com/content/13/9/e235935.full
SO  - BMJ Case Reports2020 Sep 01; 13
AB  - 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.