Fulminant Hepatic Failure Secondary to Metastatic Prostate Cancer: 1921

Introduction: In 2015, prostate cancer was the second most common cancer in American men and the second leading cause of cancer death. Although liver is a common site of metastasis for all primary solid tumors, fulminant hepatic failure remains a rare presentation of metastatic prostatic carcinoma, with a rapidly progressive course toward hepatic coma and death. In this case we present a patient with metastatic prostate cancer to the liver leading to fulminant hepatic failure and death.Figure 1Figure 2Figure 3Case Presentation: 64 year-old male with a history of prostate cancer and doing well on chemotherapy, presented with one week of weakness, confusion, jaundice and abdominal pain. As part of his routine checkup, lab work prior to admission revealed normal liver function tests. Initial labs at admission revealed AST 475, ALT 535, ALP 678 and Total Bilirubin 6.4. MRI Abdomen showing hepatomegaly with heterogeneous signal intensity of the liver parenchyma, suggestive of fatty infiltration, with metastatic liver infiltration felt to be less likely. There was no ductal dilation; given lack of a definitive diagnosis, a liver biopsy was performed. Immunostains were positive for PSA and PSAP confirming metastatic prostate adenocarcinoma. Clinically, the patient's liver enzymes continued to rise (AST 8100 ALT 1800 ALP 1700 TB 10.5) as well as worsening confusion, abdominal distention and hemodynamic instability refractory to aggressive intravenous hydration. Family decided to pursuit comfort care measures and patient expired on Day 4 of hospital admission. Discussion: Metastatic prostate cancer infrequently causes fulminant hepatic failure. In this case, we present a patient with acutely worsening liver disease with previously well controlled prostate cancer. A liver biopsy provided the accurate diagnosis as the MRI showed nonspecific heterogenous signal intensity. In patients with elevated liver function tests, the possibility of hepatic involvement by metastatic cancer should be considered as a possible cause of hepatic failure.