Acute Liver Failure With Severe Lactic Acidosis Secondary to Infiltrative Diffuse Large B-Cell Lymphoma: An Imaging-Negative Presentation

Liver involvement by non-Hodgkin's lymphoma is common in late stage disease but rarely results in severe hepatic dysfunction. Here, we discuss a case of acute liver failure (ALF) with severe lactic acidosis in a 75-year-old female with diffuse large B-cell lymphoma (DLBCL). The patient was admitted with nausea, fevers, and mild acidosis. Although radiographic imaging did not demonstrate any liver abnormality, the patient soon developed signs of ALF along with severe lactic acidosis. Despite initiation of chemotherapy, the patient deteriorated quickly and was ultimately put on comfort measures. This case highlights an uncommon manifestation of DLBCL and suggests that an accelerated timeline for beginning chemotherapy may be warranted in patients with high clinical suspicion of secondary hepatic lymphoma.