A case of malignant lymphoma together with fulminant hepatic failure

Abstract

A case of malignant lymphoma together with fulminant hepatic failure is described. This 60 year old male first noted jaundice four days before admission. On physical examination, he was severely jaundiced and the liver was palpable 10 cm below the xiphoid process, but superficial lymph nodes were not enlarged. Laboratory data revealed pronounced elevation of serum direct bilirubin and serum biliary tract enzyme activity, but abdominal ultrasonography showed no evidence of dilatation of the bile ducts. After admission, the patient ran a rapidly fatal course with fever, bleeding tendency, ascites, anuria and impaired consciousness. Postmortem examination revealed malignant lymphoma involving the liver, lymph nodes, spleen, adrenal, skin and submandibular gland. In the liver, ubiquitous infiltration in the portal areas, nodule formation by tumor cells and massive hepatic necrosis were observed. The possibility of the contribution of the univisceral Shwartzman reaction to this patient's massive hepatic necrosis is discussed. © 1981, The Japan Society of Hepatology. All rights reserved.