C0579 - What Lies Beneath the Skin? A Rare Cause of Acute Liver Failure

Miguel J. Anzalota Del Toro, MD, MPH¹, RIcardo L. Lopez Valle, MD², Jose Martin Ortiz, MD, FACG^2
1VA Caribbean Health Care System, Guaynabo, Puerto Rico; ²VA Caribbean Health Care System, San Juan, Puerto Rico

Introduction: Malignant melanoma of the liver is a rare cause of acute liver failure despite the liver being the most common affected organ by metastatic melanomas. Liver metastasis may occur months to years after the primary lesion is removed. Severe coagulopathy, as may be present in acute liver failure, might be a challenge while performing liver biopsy. Herein a case of a male with abnormal liver chemistries and a liver mass diagnosed as metastatic melanoma.

Case Description/Methods: This is the case of a 65-year-old male with history of a right mastoid melanoma s/p excision who was lost to follow-up with dermatology for several years and who presented to ER with complaints of abdominal pain, left ocular pain with decreased vision, and bone aches. Patient also reported anorexia and 30 pounds weight loss. Initial labs showed abnormal liver chemistries. Abdominal CT scan showed a large infiltrating mass occupying most of the left liver lobe, with encasing vessels, and thrombosis of the left hepatic vein. A head CT showed large soft tissue masses in the left intraconal compartment causing mass effect upon the optic nerve and eye globe with associated proptosis. Metastatic disease was suspected. Given these findings, IR service was consulted for liver biopsy, but he first required treatment for his coagulopathy. After INR reached acceptable parameters, a percutaneous liver biopsy was done. On site prep was performed by cytotechnologist and pathologist, who deemed the sample appropriate for diagnosis and with features of a melanoma. Thus, patient was diagnosed with a metastatic melanoma of the liver leading to acute liver failure. Unfortunately, the patient had rapid deterioration and progression of his disease, making him a poor candidate for palliative immuno-/radiotherapy, and was placed under hospice care.

Discussion: Diffuse liver infiltration by a melanoma is an extremely rare cause of acute liver failure, often presenting aggressively, leading to a poor prognosis and a high mortality. Recurrence of malignancy after a long period of time is often reported despite patient’s having previously achieved remission of their primary cancer. For this reason, metastatic liver cancer should be considered in patients with history of another primary malignancy. Hepatic resection has been proposed as therapeutic and potentially curative procedure. Closer follow up and early detection with liver biopsy would have been helpful in establishing an early diagnosis, leading to favorable treatment options and survival.



Disclosures:


Miguel J. Anzalota Del Toro, MD, MPH¹, RIcardo L. Lopez Valle, MD², Jose Martin Ortiz, MD, FACG². C0579 - What Lies Beneath the Skin? A Rare Cause of Acute Liver Failure, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.