EDITOR'S QUIZ: Gl SNAPSHOT. Acute liver failure in a patient with lung cancer

摘要

A 63-year-old man with locally advanced non-small-cell lung cancer presented with dyspnoea, cough and pleuritic chest pain. Examination revealed fever and dehydration with normal cardiovascular, chest and abdominal examination. Investigations: Alanine aminotransferase level 2760IUA, total bilirubin 25 mumol/l, alkaline phosphatase 188 IUA, albumin 39 gA, gamma-glutamyl transferase 318 U/l, international normalised ratio 2.0, creatinine 205mumotyl, white cell count 13.1x10~9A- Screening for causes of acute hepatitis was negative, including hepatitis A, B, C serology, paracetamol level and autoimmune profile. Chest radiograph showed right pleural effusion (fig 1). Electrocardiogram was normal.