Hepatosplenic T-cell lymphoma presenting as untreatable hepatic failure and hemophagocytic syndrome

84-year-old female presented with fever and arthralgia. She was admitted to hospital and treated antibiotics. Although her symptons were relieved, serum transaminases levels were markedly elevated. She was referred to our hospital because of suspected drug-induced liver injury. Physical examination was unremarkable except for conjunctival icterus. The results of laboratory examination at admission were as follows: T.Bil 4.16 mg/dl; AST 1209 IU/L; ALT 1110 IU/L. The liver biopsy revealed features of drug-induced hepatitis, then she was treated methylprednisolone pulse therapy. However liver failure was progressed rapidly and she developed hemophagocytic syndrome and multiple organ failure. She eventually died on day 25 of hospitalization. Autopsy revealed massive infiltration of hemophagocytic cells in the liver, spleen and bone marrow with the atypical T-cells. Finally we diagnosed as hepatosplenic T-cell lymphoma.