Metastatic small-cell lung cancer presenting as fulminant hepatic failure

We report a case of a 75-year-old woman with fulminant hepatic failure due to metastatic small-cell lung cancer (SCLC). The patient was hospitalised for the management of rapidly progressive hepatic failure. Thoracic radiology identified a widened mediastinum, and prior to hospitalisation she had received antibiotics for a urinary tract infection. Consequently, her hepatic failure was deemed to be due to either sarcoidosis with hepatic involvement or an antibiotic-related adverse event and was treated with prednisolone. However, the patient's clinical condition continued to deteriorate and a liver biopsy was obtained. Histopathology and immunohistochemistry tests demonstrated almost complete parenchymal replacement with metastatic SCLC. The patient was considered to be too unwell to receive chemotherapy and hence received best supportive care instead, and died shortly thereafter.