SMALL-CELL CARCINOMA OF THE LUNG MANIFESTING AS ACUTE HEPATIC-FAILURE

In this report, we describe four cases of small-cell carcinoma of the lung manifesting as acute hepatic failure. These cases were noteworthy for the presence of hepatomegaly and substantially increased serum la ctate dehydrogenase and uric acid levels. The ratio of normalized seru m lactate dehydrogenase to normalized serum alanine aminotransferase f rom the 4 cases reported herein (mean +/- SE, 3.63 +/- 1.10) was signi ficantly greater than the ratio obtained from the 12 cases of nonmalig nant fulminant hepatic failure (mean +/- SE, 0.46 +/- 0.18; P<0.001). Chest radiographs and abdominal imaging studies showed no neoplastic p rocess in three of the four cases. Postmortem examinations disclosed e xtensive infiltration of the liver by metastatic small-cell carcinoma of the lung. A review of the literature revealed 13 additional similar cases. We conclude that metastatic small-cell carcinoma of the lung s hould be considered in cases of acute hepatic failure associated with hepatomegaly, substantially increased lactate dehydrogenase levels in comparison with alanine aminotransferase values, and increased uric ac id levels even if imaging studies show no lesion. A liver biopsy done early during the hospital course is appropriate for diagnosis and for prevention of inappropriate transfer of the patient to a liver transpl ant center.