# Acute liver failure caused by lymphocyte-depleted Hodgkin lymphoma in tuberculosis and HIV-infected patient

## TL;DR

A rare case of acute liver failure in an HIV-infected man caused by lymphocyte-depleted Hodgkin lymphoma is described, highlighting the disease's aggressive nature and liver involvement.

## Contribution

This case report presents a rare autopsy-confirmed instance of liver failure due to lymphocyte-depleted Hodgkin lymphoma in an HIV-infected patient.

## Key findings

- LDCHL caused multiacinar confluent hepatic necrosis and acute liver failure in an HIV-infected patient.
- The case showed angiotropism and angioinvasion as mechanisms of liver damage in LDCHL.
- Tuberculous foci were found in the liver and spleen, indicating a complex interplay of infections and malignancy.

## Abstract

The lymphocyte-depleted classic Hodgkin lymphoma (LDCHL), the rarest subtype of classic Hodgkin lymphoma (CHL), is usually diagnosed at an advanced stage (stage IV) and one that unusually involves the liver, causing a rapidly progressive clinical course. We describe a 40-year-old immunocompromised man presenting with a progressive non-cholestatic jaundice and intermittent fever. The abdominal ultrasonography revealed a nodular liver with coarse echotexture and periportal hypodensities. The thoracic and abdominal contrast-enhanced computed tomography revealed right cervical and paraaortic lymphadenopathy, hepatosplenomegaly, diffuse mural thickening of duodenal and jejunal loops, and bilateral lobulated kidneys. Subsequently, he succumbed to his illness secondary to refractory septic shock. On postmortem examination, he was diagnosed with classic Hodgkin lymphoma (lymphocyte-depleted type) involving paraaortic and mediastinal lymph nodes based on morphology and immunochemistry findings. The lymphomatous process involved the liver (causing multiacinar confluent hepatic necrosis) and spleen, both showing tuberculous foci. This autopsy case depicts an uncommon case of acute liver failure due to infiltration of the liver by LDCHL in an HIV-infected patient. The findings of angiotropism and angioinvasion establish the pathological mechanism of liver failure (hepatocellular necrosis) in such cases.