Acute hepatitis-like presentation with cholestasis of CBFB-MYH11-positive acute myeloid leukemia in an adult male: a case report

J Med Case Rep. 2022 Jul 31;16(1):294. doi: 10.1186/s13256-022-03476-7.

Abstract

Background: Liver involvement in adults with acute myeloid leukemia is uncommon. Most of the case reports describe acute liver failure or obstructive jaundice, while acute hepatitis is rarely mentioned. We report a patient with acute myeloid leukemia who presented with clinical, biochemical, and radiological signs of acute hepatitis that totally regressed after chemotherapy.

Case presentation: A 38-year-old Caucasian man presented with fever, cough, and mild fatigue. Laboratory workup showed anemia, thrombocytopenia, severe leukocytosis, transaminitis, and hyperbilirubinemia. Imaging of the abdomen (ultrasound and magnetic resonance) showed hepatomegaly, splenomegaly, upper limits portal veins diameters, increased thickness of the gallbladder wall, and significant abdominal lymph nodes. Peripheral blood smear and bone marrow evaluation were consistent with acute myeloid leukemia, and liver biopsy showed massive sinusoidal and portal infiltration by leukemic cells. After remission-inducing chemotherapy, there was complete normalization of liver function tests, and liver, spleen, and portal vein size.

Conclusions: This case highlights the importance of taking acute myeloid leukemia into account as a possible cause of liver damage to make a rapid diagnosis and start appropriate treatment that may lead to hematological remission and hepatic dysfunction resolution.

Keywords: Case report; Chemotherapy; Hepatitis; Leukemia; Ultrasound.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Adult
  • Bone Marrow / drug effects
  • Bone Marrow / pathology
  • Cholestasis* / complications
  • Cholestasis* / drug therapy
  • Cholestasis* / pathology
  • Core Binding Factor beta Subunit*
  • Hepatitis* / complications
  • Hepatitis* / diagnosis
  • Hepatitis* / drug therapy
  • Humans
  • Leukemia, Myeloid, Acute* / complications
  • Leukemia, Myeloid, Acute* / drug therapy
  • Liver / drug effects
  • Liver / pathology
  • Liver / physiology
  • Liver / physiopathology
  • Male
  • Myosin Heavy Chains*

Substances

  • CBFB protein, human
  • Core Binding Factor beta Subunit
  • MYH11 protein, human
  • Myosin Heavy Chains