Hepatic Dysfunction as Presenting Manifestation of Hodgkin’s lymphoma

Citation: Taylor DF, Cho RS, Hall J, Walton D, Womeldorph CM (2016) Hepatic Dysfunction as Presenting Manifestation of Hodgkin’s lymphoma. J Gastroenterol Compl 1(1): 103 Volume 1 | Issue 1 Journal of Gastroenterology and Its Complications Introduction Hepatic dysfunction is rarely the presenting feature of malignancy, however it is important to recognize early on as the quick institution of chemotherapy could potentially reverse the liver disease. Without prompt therapy, hepatic failure is likely to occur which is characterized by encephalopathy, and coagulation deficits. There have been few case reports describing hepatic failure as the primary manifestation of Hodgkin’s lymphoma, the malignancy itself precludes the possibility of liver transplant, and often typifies advanced disease. Our case describes gentlemen that presented with hepatic dysfunction secondary to Hodgkin’s lymphoma, who was diagnosed before the onset of hepatic failure, and subsequently referred to oncology for chemotherapy. Hepatic dysfunction is a potential complication of Hodgkin’s disease that may be secondary to direct infiltration by the malignancy itself, or present as paraneoplastic manifestation of the malignancy. Hepatic dysfunction is concern as progression of the disease process may lead to hepatic failure. Fulminant hepatic failure is defined as an acute onset of liver disease compromising the liver’s synthetic function. Typical findings include hepatic encephalopathy and prolongation of the INR (>1.5) which occur within an 8 week time frame [1,2]. The most common precipitators of acute hepatic failure include viral hepatitis, medications, drugs, and toxins with less common causes including metabolic disorders and vascular disorders such as hepatic vein thrombosis [24]. Rarely is malignancy the presenting feature of liver dysfunction, but when the presentation does arise, the malignancy is typically advanced in stage, and not of hepatic origin [1-4]. This is significant as a history of malignancy precludes the patient from receiving a liver transplant [5], and if not addressed in a time, hepatic dysfunction may progress to hepatic failure. There have been numerous case reports in which a lymphoproliferative malignancy has involved the liver resulting in fulminant hepatic failure [1,3,6-9]. Hodgkin’s disease (HD) is a lymph node based disease with 4 classic histologic subtypes with similar prognostic outcomes. Hepatic involvement in HD affects approximately 5-8% of patients. Over half of patient’s will present with right upper quadrant pain, jaundice, hepatomegaly, fevers, and night sweats with a generally poor prognosis.