Before it crumbles: Fulminant Hepatic Failure secondary to Hodgkin's Lymphoma

Figures & data

Fig. 1 (a) High power view of Level 7 lymph node from the neck showing atypical cells, some of which are multinucleated and consistent with Reed–Sternberg (RS) cells although not typical. (b) Immunohistochemical stain showing RS cells positive for CD30.

Table 1 Laboratory parameters showing deterioration of coagulation parameters

Labs	Day 1	Day 8	Day 15
WBC (×10^3/mm^3)	4.8	2.3	4.8
Hb (g/dl)	6.5	7.2	7.4
Platelets (×10^3/mm^3)	145	54	18
AST (IU/L)	42	28	42
ALT (IU/L)	50	35	47
ALP (IU/L)	290	231	131
Total bilirubin (mg/dl)	1.4	1.7	10.6
Direct bilirubin (mg/dl)	0.5	0.9	6.9
PT (sec)	12.7	16.9	17.8
INR	1.2	1.5	1.6
PTT (sec)	31	36	NA
Albumin (g/dl)	1.7	1.3	1
LDH (IU/L)	410	156	NA

WBC=white cell count; Hb=hemoglobin; ALT=alanine transaminase; AST=aspartate transaminase; ALP=alkaline phosphatase; PT=prothrombin time; INR=international normalized ratio; PTT=partial thromboplastin time; LDH=lactate dehydrogenase.

Fig. 2 Graph showing deterioration of coagulation parameters.

Fig. 3 (a) Liver biopsy showing diffuse infiltration of liver by lymphoma cells with disruption of hepatic architecture and necrosis. (b) Liver biopsy showing hepatocellular necrosis and malignant infiltrate of lymphoma cells.