Hepatic involvement as the initial manifestation of B-cell acute lymphoblastic leukemia in adults: A case series

Introduction Hepatic involvement as an initial presentation of acute lymphoblastic leukemia (ALL) in adults is rare and may delay the diagnosis. Material and methods A case series of adult patients with confirmed B-cell ALL (B-ALL) and altered liver function tests at disease onset was conducted. Clinical, biochemical, imaging, and flow cytometry data were collected, ruling out infectious, autoimmune, and toxic etiologies. Results Three men, 68, 36, and 38 years of age, presented with cholestasis and hepatosplenomegaly with no biliary tract dilation. Flow cytometry showed high percentages of B lymphoblasts. One patient died shortly after starting chemotherapy and the other two remain on active treatment. Conclusion Hepatic infiltration due to ALL should be considered in the differential diagnosis of cholestasis with a normal biliary tract in adults.