Two cases of fulminant hepatic failure in malignant lymphoma

Two cases of malignant lymphoma presenting fulminant hepatic failure were reported. They were admitted with severe jaundice and disturbed consciousness. Laboratory deta revealed high levels of direct bilirubin. LDH, ALP, transaminase, and decreased prothrombin activity. Consiousness deteriorated (grade III, IV hepatic encephalopahty), therefore fulminant hepatitis was suspected. Ultrasonography showed hepatosplenomegaly and uneven internal echo of the liver. They died within several days. Histological findings of the liver revealed massive infiltration with tumor cells, and portal vein obstruction due to marked invasion with tumor cells in the subendothelium. Clinical signs and ultrasonographic findings between 11 fulminant hepatitis and these cases were compared. Clinical signs were similar but ultrasonographic findings were different. Ultrasonography is useful for early differential diagnosis between fulminant hepatitis and fulminant hepatic failure in malignant lymphoma.