Unusual peripheral T cell lymphoma presenting as acute liver failure and reappearing in the liver allograft

A 25-year-old man presented with fulminant hepatic failure from an unusual peripheral T cell lymphoma involving the liver and spleen without lymphaden opathy. He underwent liver transplantation before establishing a definitive diagnosis and 21 days later, died from liver allograft failure because of recurrent lymphoma. In both the native liver and hepatic allograft, the lym phoma presented as a sparse cytologically atypical malignant infiltrate int ermixed with numerous reactive macrophages, which showed marked angio- and epitheliotropism and irregular areas of coagulative necrosis, The malignant cells were CD3(+)/granzyme B+/TIA1(+)/CD8(-)/CD56(-)/S100(--) with variabl e staining for beta F1, CD5, and CD7. Multiplex polymerase chain reaction ( PCR) showed rearrangement of the T cell receptor gamma chain gene in the na tive and transplanted liver and spleen. Even in the absence of a mass lesio n or lymphadenopathy, peripheral T cell lymphoma should be included in the differential diagnosis of fulminant hepatic failure in young patients who s how no evidence of viral or autoimmune diseases.