Case Report

Metastatic Prostatic Carcinoma Presenting as Fulminant Hepatic Failure

Authors: Faiz A. Shakir, MD, Mohammed Madhoun, MD, Joshua Whorton, MD, Richard Harty, MD

Abstract

A 68-year-old male presented with progressive abdominal pain, dyspnea, weight loss, and dysuria. Lab work revealed elevated creatine phosphokinase levels, prostate-specific antigen level (approximately 60 ng/mL), and elevated liver enzymes. He was admitted to the intensive care unit for worsening respiratory distress and confusion. He continued to deteriorate, and his bilirubin peaked at 8.5 mg/dL. The patient subsequently died, and an autopsy revealed extensive hepatic necrosis with diffuse intravascular and intraparenchymal permeation of metastatic prostatic carcinoma. Fulminant hepatic failure remains a rare presentation of metastatic prostatic carcinoma, with a rapidly progressive course toward hepatic coma and death. A high index of suspicion is needed to investigate the possibility of palliative chemotherapy.


Key Points


* Fulminant hepatic failure is a rare presentation of malignancy, especially prostatic carcinoma.


* Histopathology usually reveals diffuse intrasinusoidal metastases; rarely, intravascular involvement is seen as well.


* Therapeutic options are limited due to the rapid course of deterioration.

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