Stealthy Invader: Clinically Inapparent But Rapidly Progressive Multifocal Metastatic Melanoma Unveiled as Root Cause of Liver Failure

Abstract

Background: Acute liver failure (ALF) secondary to metastatic melanoma presents a rare and diagnostically challenging clinical scenario.

Case report: We report the case of a 57-year-old male who succumbed to fulminant liver failure attributed to hepatic infiltration by malignant melanoma. Despite extensive diagnostic evaluation, the underlying cause of ALF remained elusive until postmortem examination revealed multifocal metastatic melanoma. Notably, the autopsy disclosed a remarkable finding: a 10 cm lymph node in the right axilla, conspicuously harboring metastatic melanoma cells. Surprisingly, this progressive lymph node was not detected on admission or during comprehensive imaging studies conducted 24 h prior to death. Rigorous cross-referencing of radiological and autopsy findings highlighted the accuracy of prior interventions visible on imaging, further accentuating the dynamic nature of metastatic melanoma progression.

Conclusion: This case underscores the importance of vigilance in detecting metastatic melanoma, even in atypical sites, and emphasizes the need for multidisciplinary collaboration in complex clinical scenarios.

Keywords: Melanoma; acute liver failure; hepatic infiltration; lymph node metastasis.