Hemophagocytic Lymphohistiocytosis and the Liver Masquerade.

We present a case of hemophagocytic lymphohistiocytosis (HLH) with a complex presentation that could have been easily mistaken as one of many alternative diagnoses. Our patient, with chronic alcohol use disorder, presented with new-onset liver symptoms and pancytopenia. This case underscores the importance of clinical suspicion and further investigation of a wide differential. The purpose of this case report is to highlight the diagnostic challenges and nuances in patient presentation that can mislead healthcare providers while emphasizing the ambiguity of liver failure symptoms in patients with undiagnosed HLH.