Subacute liver failure secondary to amyloid light-chain amyloidosis.

AL amyloidosis is an uncommon disorder leading to infiltration of several organs, with renal and cardiac involvement usually having the most clinical significance. Although hepatic involvement commonly occurs, it usually does not affect prognosis. However, our patient was an example of a patient with hepatic amyloidosis who developed a syndrome of rapidly progressive intrahepatic cholestasis associated with massive hepatomegaly and features of portal hypertension, including splenomegaly, ascites, and varices. Prompt recognition of this presentation is vital, and the use of SAP scintigraphy to view infiltrated organs is of great value, in combination with histopathologic confirmation of the diagnosis. The prognosis of these patients is grave without prompt chemotherapy or transplantation, which may not be possible if the condition is not promptly recognized. Therefore, the possibility of hepatic amyloidosis should be carefully considered by clinicians in cases of cholestatic jaundice without an apparent cause.