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Mortality due to acute liver failure is far less common than lung and heart involvement. We describe a case of fulminant liver failure with multiorgan failure presenting initially with chronic non-specific symptoms, in addition to minimal abnormal investigations such as mild anaemia, neutrophil leucocytosis and mild obstructive liver dysfunction. Presenting features included confusion, hypotension, oliguria and rapidly deteriorating liver function with severe lactic acidosis. Postmortem examination confirmed extensive systemic sarcoidosis.<\/jats:p>","DOI":"10.1136\/bcr-2014-206475","type":"journal-article","created":{"date-parts":[[2015,4,24]],"date-time":"2015-04-24T10:00:33Z","timestamp":1429869633000},"page":"bcr2014206475","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["A rare cause of severe lactic acidosis"],"prefix":"10.1136","volume":"2015","author":[{"given":"Saad","family":"Saeed","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aditya","family":"Kuravi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Rowley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marwa","family":"Saeed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2015,4,24]]},"reference":[{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(13)60680-7"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.2","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0140-6736(03)12888-7","article-title":"Sarcoidosis","volume":"361","author":"Baughman","year":"2003","journal-title":"Lancet"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.3","doi-asserted-by":"crossref","first-page":"pii: bcr0420114069","DOI":"10.1136\/bcr.04.2011.4069","article-title":"Diagnostic and therapeutic challenges of hepatic sarcoidosis","volume":"2011","author":"Mosea","year":"2011","journal-title":"BMJ Case Rep"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.4","doi-asserted-by":"publisher","DOI":"10.1097\/00005792-199903000-00001"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.5","first-page":"337","article-title":"Hepatic sarcoidosis: clinicopathologic features in thirty-seven patients","volume":"31","author":"Bilir","year":"2000","journal-title":"J ClinGartroenterol"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.6","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1016\/S1665-2681(19)31983-0","article-title":"Hepatic sarcoidosis, concise review","volume":"5","author":"Karagiannidis","year":"2006","journal-title":"Ann Hepatol"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.7","doi-asserted-by":"publisher","DOI":"10.4065\/73.5.467"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.8","doi-asserted-by":"publisher","DOI":"10.1055\/s-2002-36517"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.9","doi-asserted-by":"publisher","DOI":"10.1080\/003655200750023110"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.10","first-page":"831","article-title":"Value of liver biopsy in sarcoidosis","volume":"108","author":"Hercules","year":"1984","journal-title":"Arch Pathol Lab Med"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.11","first-page":"210","article-title":"Uncommon manifestations of sarcoidosis","volume":"52","author":"Sharma","year":"2004","journal-title":"J Assoc Physicians India"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.12","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1177\/000313480407000712","article-title":"Unusual cases of jaundice secondary to non-neoplastic bile duct obstruction","volume":"70","author":"Peyre","year":"2004","journal-title":"Am Surg"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.13","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1097\/00000478-199312000-00009","article-title":"Hepatic sarcoidosis: clinicopathological features in 100 patients","volume":"7","author":"Devaney","year":"1993","journal-title":"Am J SurgPathol"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.14","doi-asserted-by":"publisher","DOI":"10.1159\/000338355"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.15","doi-asserted-by":"publisher","DOI":"10.1097\/00042423-200205000-00002"},{"key":"2025042706055734000_2015.apr23_1.bcr2014206475.16","first-page":"612","article-title":"Sarcoidosis. 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