Dr. Maglantay, Dr. Qin, Dr. Lanjewar, Dr. Saad, Dr. Cochran, and Dr. Harper are all resident physicians, Dr. Wieczorek is the chief of anatomic pathology, Dr. Goozner is co-chief of the Section of General Internal Medicine, Dr. Blumenthal is the chief of Medical Service, and Dr. Al-Ajam is a critical care and pulmonary medicine physician, all at the Brooklyn Campus of the VA New York Harbor Healthcare System. Dr. Wieczorek is a clinical professor of pathology, Dr. Pincus is a professor of pathology, Dr. Blumenthal is a clinical associate professor of medicine, and Drs. Goozner and Al-Jam are assistant professors of medicine, all at SUNY Downstate Medical Center in Brooklyn.
References
As found in the authors’ prior study, coagulopathy, renal failure (final creatinine was 3.2 mg/dL) as well as hypoglycemia are oftentimes seen, all of which were found in the patient in this study. 4 (Coagulopathy was indicated by the low platelet count and elevated PT and aPTT.) Laboratory findings for FHF include rapid increases in serum ALTs such that the AST:ALT ratio is significantly greater than 1 and in which total protein and albumin are significantly decreased. Often there is hyperammonemia as was present in the current case.
A study has been performed to develop serodiagnostic markers to distinguish malignant from nonmalignant causes of FHF on 4 patients with tumor-induced FHF and 12 patients with FHF due to other causes. It was found that that there was an increase in the lactate dehydrogenase (LDH) to ALT ratio as well as elevated uric acid levels in the 4 patients with FHF not found in any of the 12 patients with nonmalignant causes of this condition. 19 Although LDH was not measured in this case, in view of the patient’s history of gout, the LDH/uric acid ratio may not have been discriminating.
Conclusion
Although rare, metastatic small cell carcinoma should be included in the clinical differential diagnosis of patients presenting with acute FHF with no other obvious medical etiology. Accurate and timely diagnosis is important to better guide management of these patients.
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
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