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Significant admission labs were serum creatinine: 6.15 mg\/dL, serum bilirubin: 27\u2009mg\/dL, aspartate aminotransferase (AST): 316 u\/L, alanine aminotransferase (ALT): 198\u2009u\/L and serum alkaline phosphatase: 2121 u\/L. He was admitted to the medical intensive care unit and was started on dialysis for acute renal failure. MRI of the abdomen showed multiple masses in the liver concerning for metastatic disease, cystic lesions in the pancreatic body and ascites. He underwent paracentesis and ascitic fluid analysis was positive for adenocarcinoma. CA 19-9 was 17\u2009828 u\/mL. The patient\u2019s condition gradually deteriorated, and he died of cardiac arrest.<\/jats:p>","DOI":"10.1136\/bcr-2020-235935","type":"journal-article","created":{"date-parts":[[2020,9,14]],"date-time":"2020-09-14T17:17:30Z","timestamp":1600103850000},"page":"e235935","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Acute liver failure masquerading an occult malignancy"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7831-5550","authenticated-orcid":false,"given":"Pooja","family":"Gogia","sequence":"first","affiliation":[{"name":"Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sotirios","family":"Doukas","sequence":"additional","affiliation":[{"name":"Department of Medicine, Saint Peter's University Hospital, New Brunswick, New Jersey, 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