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B-Cell Acute Lymphoblastic Leukemia with Liver Infiltration Presenting as Acute Alcoholic Hepatitis
Poster Title: B-Cell Acute Lymphoblastic Leukemia with Liver Infiltration Presenting as Acute Alcoholic Hepatitis
Submitted on 08 Sep 2020
Author(s): Katherine O'Neil; Alexis Antonopoulos; Kristen Hernandez; Marisha Sirdar MD
Affiliations: New York Institute of Technology College of Osteopathic Medicine; Church Health-Baptist Memorial Hospital Family Medicine Residency - Memphis, TN
Poster Views: 241
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Abstract: Acute hepatic injury with complete blood count (CBC) indicating an absence of peripheral cytopenias is a rare presentation of lymphoid malignancies, such as B-cell acute lymphoblastic leukemia (B-ALL). B-ALL is a relatively rare malignancy which occurs most commonly in young pediatric patient populations 1. Most patients present with complications of pancytopenia and bone marrow failure such as anemic pallor and fatigue, fragility with delayed wound healing, or increased susceptibility to infections 2. Ineffective hematopoiesis is a consequence of bone marrow infiltration by immature precursor blast cells that are pathognomonic of B-ALL.

Hepatic involvement in lymphoblastic leukemia is a frequent phenomenon usually seen late in the disease course. Signs of liver involvement such as elevated transaminases or hyperbilirubinemia is often mild or even silent at the time of diagnosis 3.

There are few reports within literature describing cases of B-ALL presenting as acute hepatitis in adolescents or young adults 4. This presentation of leukemia is to be reported so that acute lymphoblastic leukemia is kept on the differential for any previously healthy young adult presenting with acute hepatitis.
Summary: 21-year-old male presented with acute alcoholic hepatitis. Elevated LFTs with no acute changes were found on RUQ ultrasound. CBC showed increased blasts in the absence of peripheral cytopenias. Bone marrow biopsy revealed 94.5% blasts with hemophagocytic histiocytosis, consistent with B-ALL and additional concern for HLH. Liver biopsy revealed necrosis due to B-ALL infiltration alone. The patient was treated with prophylactic steroids in preparation for systemic chemotherapy.References: 1. American Cancer Society. Cancer Facts & Figures 2019. Atlanta: American Cancer Society. 2019.
2. Bruguera M, Miguel R. The Effect of Hematological and Lymphatic Diseases on the Liver. In: Rodes J, Benhaumou JP, Blei AT, Reichen J, Rizzeto M, editors. Textbook of Hepatology, 3rd edition. Oxford, UK: Blackwell 2007.
3. Kantarjian HM, Wolf RA, editors. The MD Anderson Manual of Medical Oncology, 3rd edition. New York, NY: McGraw-Hill.
4. Litten JB, Rodriguez MM, Maniaci V. Acute Lymphoblastic Leukemia Presenting in Fulminant Hepatic Failure. Pediatric Blood Cancer. 47: 842-845. 2006.
5. (Figure) K. Kaushansky, M.A. Lichtman, J.T. Prchal, M.M. Levi, O.W. Press, L.J. Burns, M. Caligiuri: Williams Hematology, 9th edition. New York, NY; McGraw-Hill.
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