Acute hepatic failure and multi-system organ failure secondary to replacement of the liver with metastatic melanoma

Abstract

Background: Metastatic malignant melanoma to the liver resulting in fulminant hepatic failure is a rare occurrence.

Case presentation: A 46 year old man presented to hospital with massive hepatomegaly, elevated liver enzymes and increased lactate three weeks following resection of a malignant melanoma from his shoulder (Clark level 5). Initially stable, he decompensated 24 to 48 hours subsequent to presentation with respiratory failure requiring mechanical ventilation, distributive shock requiring high dose vasopressor infusion, coagulopathy refractory to plasma infusion, progressive rise in liver enzymes and severe metabolic abnormalities including hyperkalemia, acidosis, hyperphosphatemia, hyperuricemia and hypocalcemia. Refractory to aggressive physiologic support he received palliation. Autopsy revealed >80% liver infiltration by metastatic malignant melanoma.

Conclusion: We report a case of fulminant hepatic failure secondary to metastatic malignant melanoma infiltration of the liver.

Figure 1

Liver biopsy contains numerous neoplastic elongate cells consistent with malignant melanoma infiltration.

Figure 2

Immunohistochemistry of the liver. S-100 antibody stains malignant melanocytes with a brown chromogen (diaminobenzidine). Rare negative cells (blue due to hematoxylin counterstaining) are intact hepatocytes.