Atypical presentation of secondary hepatic lymphoma with severe hepatic involvement: A case report and literature review

Rationale: While secondary hepatic lymphoma can develop in up to 50% of patients with non-Hodgkin lymphoma and approximately 20% of those with Hodgkin disease, it is uncommon for patients to present with severe hepatic involvement, manifesting initially as jaundice and abdominal pain. These nonspecific symptoms can complicate diagnosis and subsequently delay the initiation of appropriate treatment. Patient concerns: A 68-year-old female presented to our hospital with complaints of abdominal pain and jaundice. Diagnoses: Laboratory tests and clinical symptoms are often nonspecific for this atypical presentation of secondary hepatic lymphoma, and imaging findings can be challenging to distinguish. Histopathological examination remains the gold standard for diagnosis. Interventions: Due to severe thrombocytopenia and coagulopathy, only low-dose prephase chemotherapy was administered along with supportive treatments, including platelet transfusion and coagulation factor supplementation. Outcomes: The patient was dead. No autopsy was performed, as the patient’s family declined consent. Lessons: Clinicians should maintain high vigilance for atypical presentations of lymphoma, especially when encountering unexplained cholestatic hepatitis and cytopenias, and promptly initiate diagnostic evaluations to avoid delays in treatment. A definitive diagnosis primarily relies on histopathological examination, with chemotherapy remaining the cornerstone of treatment.