Case Report Fulminant Hepatic Failure Secondary to Primary Hepatic Angiosarcoma Ayokunle T. Abegunde, 1,2 Efe Aisien, 1 Benjamin Mba, 1 Rohini Chennuri, 3 and Marin Sekosan 3 1 Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA 2 Department of Medicine, Section of Digestive Diseases and Nutrition, Oklahoma University Health Sciences Center, Oklahoma City, OK 73104, USA 3 Department of Pathology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL 60612, USA Correspondence should be addressed to Ayokunle T. Abegunde; abegs@doctors.org.uk Received 11 December 2014; Accepted 7 February 2015 Academic Editor: Haruhiko Sugimura Copyright © 2015 Ayokunle T. Abegunde et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Hepatic angiosarcoma is a rare and aggressive tumor that oten presents at an advanced stage with nonspeciic symptoms. Objective. To report a case of primary hepatic angiosarcoma in an otherwise healthy man with normal liver function tests two months prior to presenting with a short period of jaundice that progressed to fulminant hepatic failure. Methods. Case report and review of literature. Conclusion. his case illustrates the rapidity of progression to death ater the onset of symptoms in a patient with hepatic angiosarcoma. Research on early diagnostic strategies and newer therapies are needed to improve prognosis in this rare and poorly understood malignancy with limited treatment options. 1. Case Report A 75-year-old man presented to our hospital with three- week history of anorexia, abdominal fullness, chills, and three-day history of jaundice. He was diagnosed with AV nodal reentry tachycardia (AVNRT) six months earlier which terminated with the Valsalva maneuver. His medication included Diltiazem and Aspirin. He had no further episodes of AVNRT and liver enzymes were normal at routine follow- up in the cardiology clinic two months before presentation. On admission he was afebrile and reported no abdom- inal pain, hematemesis, melena, or pale stools. Physical examination revealed a frail looking man with skin and scleral icterus, normal heart sounds, and blood pressure. Abdominal examination revealed epigastric tenderness with- out organomegaly or ascites. Laboratory tests were signiicant for total bilirubin 9 mg/dL, albumin 4.0 g/dL, alkaline phos- phatase 383 U/L, gamma-glutamyl transferase 701 U/L, aspar- tate aminotransferase, 104 U/L, alanine aminotransferase 206 U/L, and lactate dehydrogenase 451 U/L. Carcinoem- bryonic antigen (CEA) and alpha fetoprotein (AFP) levels were normal and CA19-9 was 38.8 IU/mL. Human immun- odeiciency virus (HIV) and hepatitis panel were negative. Chest X-ray was normal and ECG showed sinus tachycardia. Abdominal ultrasound scan was negative for cholelithiasis and cholecystitis. Contrast enhanced triple-phase comput- erized tomography scan of his abdomen showed a hepatic mass measuring 13 × 11 × 10 cm with small dilated bile ducts surrounding the mass (Figure 1). here was no common bile duct (CBD) dilatation. Liver abscess, metastases, atypical hepatocellular carcinoma (HCC), and hepatic cystadenocar- cinoma were considered in the diferential diagnosis. He developed a fever on the second day of hospitalization and was started on piperacillin-tazobactam. Pan cultures were negative and he continued to spike fevers despite intravenous antibiotics. Eventually, his fever subsided and he underwent CT guided percutaneous biopsy of the hepatic mass. He was discharged home uneventfully 4 days later. Histopathology Hindawi Publishing Corporation Case Reports in Gastrointestinal Medicine Volume 2015, Article ID 869746, 8 pages http://dx.doi.org/10.1155/2015/869746