Non-Metastatic Cholestatic Liver Injury as a Presenting Sign of a Rare Hematologic Malignancy: First Reported Case

A 55 year old Caucasian male was referred to the hospital for evaluation of abdominal pain, increasing abdominal girth and general malaise since the past few months. During his interview he endorsed poor appetite but denied any nausea or vomiting. He had not noted any change in his bowels. He had maintained a clear sensorium throughout. He admitted to drinking 7-8 beers daily and had been doing so since the past 8 years. He stated his generalized abdominal pain had greatly worsened the past week, he was increasingly lethargic and he had noticed his urine was darker. On physical examination he had a low-grade temperature and was slightly tachycardic. He appeared to be of thin-build overall. His abdomen was protuberant, non-tender on palpation and dull to percussion. Mild lower extremity edema was found. No other stigmata of chronic liver disease were present.