ADDRESSING THE INFILTRATIVE PATTERN: COMPLEX DIAGNOSIS

Abstract

Introduction and objective: Alterations in liver function tests are frequent, so the approach based on the predominant alteration and the patient's medical history is relevant. Carrying out a liver biopsy in cases of diagnostic doubt is imperative. The objective of this work is to describe a clinical case of an infiltrative pattern approach that culminated in the diagnosis of Hepatosplenic T-cell Lymphoma (HSCTL). Patients and Methods: Clinical case report. Presentation. Woman, 72 years old. History of a sister with cirrhosis. Consumption of alcohol and herbalists; arterial hypertension and Sjögren. He was admitted for persistent fatigue and jaundice. Laboratories with anemia, thrombocytopenia and kidney injury; Hepatic biochemistry with a predominantly cholestatic pattern at the expense of alkaline phosphatase and direct hyperbilirubinemia. Without acute liver failure. By imaging the liver, vessels and normal bile duct; splenomegaly; Negative hepatitis viral panel, positive ANAs and Anti-actin, negative antimitochondrials, normal immunoglobulins. HAI vs. DILI / HILI is suspected. Liver biopsy reports HSTCL-type lymphoproliferative process (Figure 1). It was supplemented with bone marrow aspirate and PET-CT. He started prednisone and cyclophosphamide. Discussion: The systematic approach to altered liver biochemistry requires integrating personal and family risk factors for liver disease. The infiltrative pattern that resembles the cholestatic one represents a diagnostic challenge as it is little recognized. In this case, we report a rare neoplasm corresponding to 5% of peripheral T lymphomas; they usually develop in young adults and in the absence of lymphadenopathy. It also has an adverse prognosis due to refractoriness to chemotherapy. Conclusion: The HSTCL presented in this clinical case represents a complex and infrequent diagnosis. The symptoms and age group were atypical and the identification was possible through a systematic evaluation of the infiltrative pattern and differential diagnoses.The authors declare that there is no conflict of interest.