B-cell Acute Lymphoblastic Leukemia Presenting as Acute Liver Injury: A Case Report

We present a case of a patient with jaundice who was referred to our facility due to markedly elevated liver enzymes and pancytopenia. The patient's only symptom was jaundice, prompting an initial evaluation at an outside hospital, where laboratory tests revealed significantly elevated liver enzymes and pancytopenia, leading to referral for further assessment. The presence of both elevated liver enzymes and pancytopenia helped narrow the differential diagnoses. Persistent pancytopenia necessitated a bone marrow biopsy for definitive diagnosis. Additionally, given the ongoing elevation of liver enzymes without an apparent infectious or inflammatory cause, a liver biopsy was also performed. The results revealed leukemic infiltration of the liver and the presence of B-cell leukemia in the bone marrow. Further laboratory findings met the diagnostic criteria for hemophagocytic lymphohistiocytosis (HLH) secondary to leukemia. The patient was treated with steroid therapy for HLH, followed by chemotherapy and immunotherapy for B-cell acute lymphoblastic leukemia, leading to sustained remission and normalization of liver function. Thirteen months after diagnosis, the patient remains in good health and continues blinatumomab-prednisone, vincristine, 6-mercaptopurine, and methotrexate consolidation therapy.