A woman presenting with an unusual cause of fulminant liver failure and sepsis

Yannis K Valtis; Trevor Barlowe; Jonathan H Young; Andrew H Lichtman; Lei Zhao; Jason L Hornick; James M Cleary; Nikroo Hashemi; Alan Cubre; Rebecca M Baron

doi:10.1016/j.clinre.2021.101836

A woman presenting with an unusual cause of fulminant liver failure and sepsis

Clin Res Hepatol Gastroenterol. 2022 Mar;46(3):101836. doi: 10.1016/j.clinre.2021.101836. Epub 2021 Nov 18.

Authors

Affiliations

¹ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: yvaltis@bwh.harvard.edu.
² Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
³ Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁴ Center of Gastrointestinal Oncology, Dana Farber Cancer Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁵ Department or Radiology, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
⁶ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.

PMID: 34800682
DOI: 10.1016/j.clinre.2021.101836

Abstract

We present the case of a 61-year-old woman who presented with acutely worsening right upper quadrant pain and was found to be in acute liver failure with Klebsiella pneumoniae bacteremia. Despite aggressive intensive care management, the patient ultimately died of refractory shock attributed to sepsis and fulminant liver failure. On autopsy, she was found unexpectedly to have diffuse intrahepatic cholangiocarcinoma with metastases to regional lymph nodes and intravascular spread to the lungs. The case highlights a rare instance where intrahepatic cholangiocarcinoma presents with acute liver failure and discusses key intensive care management principles of this clinical syndrome.

Publication types

Case Reports

MeSH terms

Cholangiocarcinoma* / pathology
Female
Humans
Liver Failure, Acute* / etiology
Middle Aged
Sepsis* / complications