Acute Liver Failure Complicated by Cytokine Storm: Diagnostic Dilemma and Management Strategies: A Case Report.

Acute liver failure (ALF) may present with hemodynamic instability often mistaken for sepsis; however, cytokine storm syndrome (CSS), a hyperinflammatory condition, can mimic sepsis and delay timely interventions. We report a 15-year-old with ALF, refractory shock, and negative cultures, ultimately diagnosed with CSS. Plasma exchange offered transient benefit, but definitive improvement followed living donor liver transplantation. Early recognition enabled timely transplant and full recovery. In ALF patients with shock unresponsive to antibiotics and no identifiable infection, CSS should be considered. Cytokine profiling and clinical suspicion are key to prompt diagnosis and management.