Fulminant hepatic failure as a presenting paraneoplastic manifestation of Hodgkin's disease

Malignancies may uncommonly present as fulminant hepatic failure and, due t o the rarity of such an occurrence, they may easily be overlooked as one of its possible causes. An unusual case of Hodgkin's disease presenting as a fulminant hepatic failure is reported. A 34-year-old man presented with an acute onset of liver failure characterized by jaundice, ascites, encephalop athy and bleeding diathesis. Chemotherapy was initiated, resulting in a dra matic improvement not only in the patient's level of consciousness, but als o in prothrombin time. Unfortunately, he succumbed shortly after to dissemi nated candidiasis. A post-mortem needle liver sample revealed massive hepat ocellular necrosis, but no liver infiltration by the neoplastic disease. We conclude that in Hodgkin's disease, involvement of the liver can be manife sted as a syndrome of paraneoplastic fulminant hepatic failure. In such cas es, liver transplantation is an absolute contraindication but urgent chemot herapy under antifungal surveillance can be life saving. fur J Gastroentero l Hepatol 11:1055-1058 (C) 1999 Lippincott Williams & Wilkins.