Liver failure due to metastatic melanoma: A case report

Abstract

BACKGROUND

Acute liver failure (ALF) due to diffuse hepatic infiltration by metastatic melanoma is extremely rare and often misdiagnosed. In the absence of prior malignancy, this presentation can mimic other hepatic emergencies such as Budd-Chiari syndrome. Early identification is crucial, especially in transplant candidates, to prevent inappropriate management.

CASE SUMMARY

A 61-year-old male presented with jaundice, abdominal distension, and encephalopathy. Liver imaging suggested acute Budd-Chiari syndrome, and liver transplantation was considered. However, biopsy revealed extensive hepatic infiltration by human melanoma black-positive melanoma cells. There was no known cancer history, although retrospective symptoms suggested uveal localization as a possible primary site. The patient rapidly deteriorated and died. A review of 12 similar cases revealed shared diagnostic challenges, frequent misdiagnoses, and poor outcomes.

CONCLUSION

Infiltrative melanoma should be considered in unexplained ALF, even without previously known malignancy.

Keywords: Acute liver failure; Melanoma; Budd-Chiari syndrome; Hepatic infiltration; Case report

Core Tip: Acute liver failure (ALF) due to diffuse hepatic infiltration by metastatic melanoma is an exceptionally rare and often misdiagnosed entity, especially in patients without a known history of malignancy. This case highlights the importance of considering infiltrative malignancy in unexplained ALF, even when initial imaging suggests vascular etiologies such as Budd-Chiari syndrome. Liver biopsy remains essential for accurate diagnosis and may alter transplant eligibility. Early recognition and histopathologic confirmation are critical for guiding appropriate clinical decisions in this rapidly fatal presentation.