Acute lymphoblastic leukemia presenting in fulminant hepatic failure

Area of Science:

• Pediatric Hematology Oncology
• Hepatology
• Critical Care Medicine

Background:

• Acute liver failure in children can have diverse etiologies.
• Early diagnosis and intervention are critical for pediatric patients with liver failure.

Observation:

• A 4-year-old boy presented with jaundice, lethargy, elevated ammonia, and abnormal liver function tests.
• Initial investigations ruled out viral hepatitis and hepatotoxic drug exposure.
• The patient was admitted for a potential living-related hepatic transplant.

Findings:

• Intraoperative frozen section revealed massive hepatic leukemic infiltration and hepatocellular necrosis.
• Bone marrow aspiration confirmed acute lymphoblastic leukemia (ALL).
• The patient died due to systemic leukemic infiltration, cerebral edema, and anoxic ischemic encephalopathy.

Implications:

• This case highlights the rare presentation of acute lymphoblastic leukemia (ALL) as acute liver failure in children.
• It underscores the importance of considering hematologic malignancies in the differential diagnosis of pediatric acute liver failure.
• Timely diagnosis and appropriate management strategies are crucial, though outcomes can be poor in fulminant cases.