Liver failure as first manifestation of a hepatic lymphoma.

Acute liver failure (ALF) is a rapidly progressive and potentially fatal condition in which successful treatment depends on the prompt identification of the underlying cause. We report the case of a 66-year-old woman who presented with severe hepatitis, marked coagulopathy, hyperbilirubinemia, and bicytopenia, while common etiologies of ALF were excluded. Imaging studies and initial bone marrow diagnostics did not provide a conclusive explanation. Subsequent histopathological evaluation of liver and bone marrow biopsies ultimately revealed hepatosplenic T-cell lymphoma, a rare and diagnostically challenging entity that may initially present as ALF. Despite planned chemotherapy, the patient experienced rapid deterioration of liver function and died from progressive liver failure. This case highlights the importance of early histological assessment - particularly via transjugular liver biopsy - in patients with unexplained ALF. It also underscores that hematologic malignancies should be considered even in the absence of typical systemic manifestations and that timely diagnostic evaluation is crucial for guiding urgent therapeutic decisions.