Fulminant hepatic failure: An unusual presentation of metastatic liver disease

Over a 2-yr period, 3 patients with metastatic liver disease presented with a clinical course compatible with fulminant hepatic failure. The course was characterized by abdominal pain, jaundice, rapidly deteriorating mental status, high-serum enzyme values (SGOT, LDH, alkaline phosphatase), prolonged prothrombin times, and death within 1-12 days after hospitalization. At autopsy a similar histologic picture was present in each: extensive infiltration and replacement of liver by tumor and widespread infarction of remaining parenchyma. To place these 3 cases into a proper perspective, they were compared with 3 similar, previously reported cases (1 primary and 2 metastatic); and a retrospective autopsy review of metastatic liver disease occurring over a 4-yr period was performed. Fulminant hepatic failure due to extensive parenchymal infarction appears to represent an uncommon, but distinct entity in the overall spectrum of metastatic liver disease.