Fulminant hepatic failure in a patient with advanced extragonadal germ cell tumour

This is a heartening report which reflects what a diligent team of clinicians can achieve in terms of patient management. It is about a 36 year old man who noticed swelling in his right lower limb and eventually he was found to have not only a deep vein thrombosis to explain the right limb swelling but also a large intrabdominal tumor that was responsible for his deep vein thrombosis.

This was just the beginning of the ordeal for this man as soon after in three weeks he went on to develop severe hepatitis and altered sensorium due to liver failure.

Undaunted the clinical team went on to administer chemotherapy to the man along with ongoing investigations such as liver biopsy for his liver failure.

The patient recovered from all these formidable challenges and yet again was found to have endocarditis which was managed commendably by the multidisciplinary team with valve replacement.

This case also reiterates the potentially life-saving importance of using chemotherapy in patients with potentially-curable, chemotherapy-responsive tumours, even when the patient is critically ill, and the value of a multi-disciplinary team in a specialist cancer centre in achieving a cure for such patients. This particular case involved the input of medical oncologists, intensive care specialists, hepatologists, neurologists, cardiothoracic surgeons and a rehabilitation team, each of which provided essential input in their specialist area.

Altogether a triumph of modern medicine which needs to be documented and celebrated more often.

Rakesh Biswas
Deputy Editor

Fulminant hepatic failure in a patient with advanced extragonadal germ cell tumour