TY - JOUR
AR - TCR-2020-2-104
TI - Metastatic Breast Cancer Presenting as Acute Liver Failure
AU - Cristina, Calogero
AU - Sanaa, Arastu
AU - Dina, Halegoua-DeMarzio
JO - Transplantation Case Reports
PY - 2020
DA - Tue 08, Sep 2020
SN - 2733-2527
DO - http://dx.doi.org/10.31487/j.TCR.2020.02.04
UR - https://www.sciencerepository.org/metastatic-breast-cancer-presenting-as-acute-liver-failure_TCR-2020-2-104 
KW - Fulminant liver failure, metastatic breast cancer
AB - Acute liver failure (ALF) is a rare clinical syndrome, with up to 20% of cases having no known etiology. Of
the many causes, initial presentation of metastatic carcinoma is rare, with malignant infiltration of the liver
usually diagnosed postmortem. We present a case of fulminant liver failure caused by a new diagnosis of
metastatic breast cancer. A 55-year-old female with no significant medical history presented with fatigue
and jaundice for one month and one week of pruritus and lower extremity edema. On presentation, she had
a MELD-Na of 38 with confusion, therefore prompting rapid liver transplant evaluation. An abdominal
ultrasound revealed cirrhotic morphology of the liver, ascites, and marked hepatic echogenicity. An
abdominal MRI needed for listing revealed an enlarged liver that was replaced by innumerable ringenhancing lesions concerning for metastasis. A liver biopsy was performed and revealed metastatic
carcinoma consistent with breast primary with no underlying cirrhosis. Transplant workup was terminated,
and the patient was referred to Oncology and Palliative Care for further management. We report a clinical
lesson regarding the importance of confirming prior liver disease prior to transplant listing. Rare
presentations such as this argue towards liver biopsy prior to listing ALF patients of unknown etiology.