Fulminant Hepatic Failure as the Initial Presentation of Hodgkin's Disease and Liver Transplantation: A Case Report

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DOI:

https://doi.org/10.5195/ijms.2024.2422

Keywords:

Hodgkin disease, Liver failure, Transplantation, Case Report, Hepatic Failure, Fulminant, Liver Transplantation, Adolescent, Hispanic Americans, Chemotherapy, Adjuvant, BEACOPP Protocol, Reed-Sternberg Cells, Lymphoma, Non-Hodgkin, Neoplasm Staging, Immunosuppressive Agents, Anemia, Iron-Deficiency, Pancytopenia, Orthotopic Liver Transplantation, Pathology, Surgical, Biopsy, Needle, Lymph Nodes, Complete Remission, Disease-Free Survival

Abstract

Background: Hodgkin's disease, a B-cell neoplasm, primarily impacts lymph nodes or extranodal lymphoid tissue. It includes two distinct entities: classical (95%) and lymphocyte-predominant nodular. While the disease commonly manifests as the growth of cervical and intrathoracic lymph nodes in 60-90% of cases, there are rare instances where Hodgkin’s disease has been linked to fulminant liver failure, carrying a very poor prognosis.

The Case: We present the case of a 13-year-old Hispanic female, who started with an insidious condition that evolved to fulminant hepatic failure of unknown etiology with an AST of 770 mg/dl. It was decided to perform an orthotopic liver transplant, the histopathological analysis of the explant and a lymph node reported mixed cellularity Hodgkin's disease. Subsequently, the hematology service requested a lumbar puncture, with no evidence of infiltration. It was decided to initiate six cycles of chemotherapy (CTX) with BEACOPP (bleomycin, etoposide, adriamycine, cyclophosphamide, vincristine, procarbazine, and prednisone) scheme, evolving without complications and achieving a complete response eleven months later; currently, she has been free of disease for three years.

Conclusion: The etiology of Hodgkin's disease in our 13-year-old patient remains elusive, emphasizing the importance of early diagnosis and diverse treatment approaches. Despite limited hospital resources, the decision to proceed with the transplant was driven by the potentially fatal outcome if left untreated. Future considerations may necessitate individualizing each case, and carefully assessing the risks and benefits associated with transplantation.

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The image for the case report features a detailed illustration of a liver, depicting both the external organ and a magnified view of liver tissue, highlighting pathological changes indicative of disease. Elements suggestive of liver transplantation are woven into the design, including icons that represent surgical intervention. Subtle references to Hodgkin's disease, such as depictions of abnormal B-cells or Reed-Sternberg cells, are integrated to emphasize the diagnosis. The overall design is academic and professional, with a color palette of clinical blues and reds, adding a sense of precision and urgency appropriate for a medical setting.

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Published

2023-12-11 — Updated on 2024-04-12

How to Cite

Saldaña Ruiz, M. A., Ortiz-Alonso, F., Sandoval-González, A. C., Tapia-Brito, L. S., Lozano-Galván, L. C., & Ramírez-Pintor, K. M. (2024). Fulminant Hepatic Failure as the Initial Presentation of Hodgkin’s Disease and Liver Transplantation: A Case Report. International Journal of Medical Students, 12(1), 92–95. https://doi.org/10.5195/ijms.2024.2422

Issue

Vol. 12 No. 1 (2024)

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Case Report

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Copyright (c) 2023 Mauricio Alejandro Saldaña Ruiz, Federico Ortiz-Alonso, Adriana Carolina Sandoval-González, Liliana Sayuri Tapia-Brito, Laura Carolina Lozano-Galván, Karla Monserrat Ramírez-Pintor

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