Successful Treatment of Diffuse Large B-cell Lymphoma Presenting as Acute Liver Failure

Diffuse Large B-Cell Lymphoma (DLBCL) is the most common histologic subtype of lymphoma. Affected patients most commonly present with rapid lymph node enlargement in the neck, abdomen, or chest, with extranodal disease occurring in up to 40% of all cases. Generally, DLBCL is a clinically aggressive malignancy and the presence of extranodal disease is a poor prognostic indicator. Acute Liver Failure (ALF) is a rare presentation of extranodal DLBCL that is typically associated with a bleak prognosis; however, the impact of prompt diagnosis followed by initiation of appropriate chemotherapy in this setting is not well understood. Further complicating treatment, first-line chemotherapy regimens for DLBCL are typically contraindicated in the setting of liver failure. In this case report, we describe the successful treatment of DLBCL originally presenting as ALF through bridging therapy with a non-standard bendamustinebased approach.