Liver failure due to metastatic melanoma: A case report

Acute liver failure (ALF) due to diffuse hepatic infiltration by metastatic melanoma is extremely rare and often misdiagnosed. In the absence of prior malignancy, this presentation can mimic other hepatic emergencies such as Budd-Chiari syndrome. Early identification is crucial, especially in transplant candidates, to prevent inappropriate management.

A 61-year-old male presented with jaundice, abdominal distension, and encephalopathy. Liver imaging suggested acute Budd-Chiari syndrome, and liver transplantation was considered. However, biopsy revealed extensive hepatic infiltration by human melanoma black-positive melanoma cells. There was no known cancer history, although retrospective symptoms suggested uveal localization as a possible primary site. The patient rapidly deteriorated and died. A review of 12 similar cases revealed shared diagnostic challenges, frequent misdiagnoses, and poor outcomes.

Infiltrative melanoma should be considered in unexplained ALF, even without previously known malignancy.