Fulminant Hepatic Failure as the Initial Presentation of Hodgkin's Disease and Liver Transplantation: A Case Report





Hodgkin disease, Liver failure, Transplantation, Case Report, Hepatic Failure, Fulminant, Liver Transplantation, Adolescent, Hispanic Americans, Chemotherapy, Adjuvant, BEACOPP Protocol, Reed-Sternberg Cells, Lymphoma, Non-Hodgkin, Neoplasm Staging, Immunosuppressive Agents, Anemia, Iron-Deficiency, Pancytopenia, Orthotopic Liver Transplantation, Pathology, Surgical, Biopsy, Needle, Lymph Nodes, Complete Remission, Disease-Free Survival


Background: Hodgkin's disease, a B-cell neoplasm, primarily impacts lymph nodes or extranodal lymphoid tissue. It includes two distinct entities: classical (95%) and lymphocyte-predominant nodular. While the disease commonly manifests as the growth of cervical and intrathoracic lymph nodes in 60-90% of cases, there are rare instances where Hodgkin’s disease has been linked to fulminant liver failure, carrying a very poor prognosis.

The Case: We present the case of a 13-year-old Hispanic female, who started with an insidious condition that evolved to fulminant hepatic failure of unknown etiology with an AST of 770 mg/dl. It was decided to perform an orthotopic liver transplant, the histopathological analysis of the explant and a lymph node reported mixed cellularity Hodgkin's disease. Subsequently, the hematology service requested a lumbar puncture, with no evidence of infiltration. It was decided to initiate six cycles of chemotherapy (CTX) with BEACOPP (bleomycin, etoposide, adriamycine, cyclophosphamide, vincristine, procarbazine, and prednisone) scheme, evolving without complications and achieving a complete response eleven months later; currently, she has been free of disease for three years.

Conclusion: The etiology of Hodgkin's disease in our 13-year-old patient remains elusive, emphasizing the importance of early diagnosis and diverse treatment approaches. Despite limited hospital resources, the decision to proceed with the transplant was driven by the potentially fatal outcome if left untreated. Future considerations may necessitate individualizing each case, and carefully assessing the risks and benefits associated with transplantation.


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Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer 2011;105:1684-92.

Siegel RL, Miller KD, Jemal A. Cancer statistics, 2017. CA Cancer J Clin 2017;67(1):7-30.

Jiménez-Ríos G, Balderas-Delgado C, Vargas-Bravo CA, Díaz-Hernández PI, Velasco-Vargas CA, Velázquez-Guerrero D et al. Experience of haematopoietic progenitor cell transplantation in Hodgkin's lymphoma at the Regional High Speciality Hospital of Ixtapaluca. Rev Mex Traspl. 2023; 12 (1): 45-9. Spa

Karmacharya P, Bhandari N, Aryal MR, Pandit AA, Pathak R, Ghimire S et al. Before it crumbles: Fulminant Hepatic Failure secondary to Hodgkin’s Lymphoma. J Community Hosp Intern Med Perspect. 2014; 4 (5): 25821.

Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis 1970; 3: 282-98

Rowbotham D, Wendon J, Williams R. Acute liver failure secondary to hepatic infiltration: a single centre experience of 18 cases. Gut.1998;42:576-80.

Squires JE, Alonso EM, Ibrahim SH, Kasper V, Kehar M, Martinez M et al. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Diagnosis and Management of Pediatric Acute Liver Failure. J Pediatr Gastroenterol Nutr. 2022; 74(1):138-58.

Woolf KMW, Wei MC, Link MP, Arber DA, Warnke RA. Nodular lymphocyte-predominant Hodgkin lymphoma presenting as fulminant hepatic failure in a pediatric patient: a case report with pathologic, immunophenotypic, and molecular findings. Appl Immunohistochem Mol Morphol. 2008;16(2):196-201.

Brannigan L, Etheredge HR, Beretta M, Demopoulos D, Bennett KG, Beringer N et al. Successful ABO-incompatible living donor liver transplant for acute liver failure secondary to Hodgkin's Lymphoma in a child. Pediatr Transplant. 2020; 24(7):e13796.

Hong FS, Smith CL, Angus PW, Crowley P, Ho WK. Hodgkin lymphoma and fulminant hepatic failure. Leuk Lymphoma. 2010; 51(5):947-51.

Hope BC, Chau KY, Evans HM, Mouat S, Munn S, Yeong ML et al. Hodgkin disease relapse discovered at the time of liver transplant for acute liver failure. Pediatr Transplant. 2012; 16(1): E10–E14.

The image for the case report features a detailed illustration of a liver, depicting both the external organ and a magnified view of liver tissue, highlighting pathological changes indicative of disease. Elements suggestive of liver transplantation are woven into the design, including icons that represent surgical intervention. Subtle references to Hodgkin's disease, such as depictions of abnormal B-cells or Reed-Sternberg cells, are integrated to emphasize the diagnosis. The overall design is academic and professional, with a color palette of clinical blues and reds, adding a sense of precision and urgency appropriate for a medical setting.


2023-12-11 — Updated on 2024-04-12

How to Cite

Saldaña Ruiz, M. A., Ortiz-Alonso, F., Sandoval-González, A. C., Tapia-Brito, L. S., Lozano-Galván, L. C., & Ramírez-Pintor, K. M. (2024). Fulminant Hepatic Failure as the Initial Presentation of Hodgkin’s Disease and Liver Transplantation: A Case Report. International Journal of Medical Students, 12(1), 92–95. https://doi.org/10.5195/ijms.2024.2422



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