P1885 - A Rare Case of Acute Decompensated Liver Failure in a Patient With Marchiafava Bignami Disease Associated With Poor Outcome

Mohammad Aldiabat, MD, Maram Alkhdour, MD, Mubarak Yusuf, MD, Yasir Saeed, MD, Afsheen Afzal, MD
Lincoln Hospital Medical Center, New York, NY

Introduction: Marchiafava-Bignami disease is a rare disorder manifested by degeneration of the corpus callosum and surrounding white matter in chronic alcoholics who are prone to malnutrition that carries a poor prognosis. Patients with Marchiafava-Bignami disease can develop acute liver failure in the setting of excessive alcohol consumption which place them at higher risk of mortality. In this abstract we present a rare case of a 33 years old female with a history of Marchiafava-Bignami disease who developed acute decompensated liver failure and acute pancreatitis that was associated with poor outcome. Up to our knowledge, this association has never been reported before in literature.

Case Description/Methods: This is a 33 years old female with past medical history of Marchiafava-Bignami disease secondary to excessive alcohol use who was found with altered mental status and shortness of breath with multiple empty bottles of hard liquor at her apartment. Upon arrival at the emergency department, the patient was found with hypoxia, hypotension and tachypnea. Physical examination was remarkable for icterus, delayed capillary refill time, abdominal distention, epigastric tenderness, shifting dullness and hepatomegaly. Labs were remarkable for thrombocytopenia, INR of 2.9, hypoglycemia, hypoalbuminemia, direct hyperbilirubinemia, elevated liver enzymes, elevated lipase levels, acute kidney injury, lactic acidosis and alcohol level of 351 mg/dl. Paracentesis showed no SBP. CT head showed cerebral cortical volume loss. Abdominal ultrasound showed hepatomegaly and fatty infiltration. Patient was admitted to ICU for management of acute decompensated liver failure and pancreatitis secondary to alcohol intake, type 4 respiratory failure and septic shock. Patient developed multiorgan failure within the next 4 days and eventually developed cardiac arrest.

Discussion: Chronic and excessive alcohol consumption in patients with Marchiafava-Bignami disease can be complicated with various conditions such as acute decompensated liver failure, pancreatitis, metabolic disorders and malnutrition, therefore increasing the risk of mortality in this group of patients. Up to our knowledge the association illustrated in the case above was never reported in literature before and writers of this report aim to increase awareness of the risk of serious gastrointestinal conditions in patients with Marchiafava-Bignami disease.

Test	Result	Reference
Platelets	89	150 - 450 x10(3)/mcL
Anion gab	28	8.0 - 16.0 mEq/L
HCO3	17	22 - 29 mmoL/L
BUN	15	6.0 - 23.0 mg/Dl
Creatinine	1.59	0.50 - 0.90 mg/dL
Glucose	59	74 - 109 mg/dL
ALK PHOS	187	35 - 105 U/L
ALT	548	< =33 U/L
AST	3147	< =32 U/L
Albumin	2.4	3.5 - 5.2 g/dL
Total Bilirubin	10.48	0.20 - 1.20 mg/dL
Direct Bilirubin	7.2	0.00 – 0.30 mg/dl
Ammonia	156	11 - 51 umol/L
Lactate	12.2	0.50 - 2.20 mmol/L
APTT	40.8	25.0 - 35.3 Seconds
INR	2.9	mg/Dl
D-Dimer Quant	1378	< =230 ng/mL
Ethanol	351.2	< =10.0 mg/dL
pH arterial	7.25	7.350 - 7.450
Blood cultures	No growth	No growth
Ascites Neutrophils	28	%
Ascites WBCs	32	0 - 5/ul
Ascites albumin	0.3	g/dl
Ascites protein	< 1.0	g/dl

Table: Laboratory tests and results at admission.


Disclosures:
Mohammad Aldiabat indicated no relevant financial relationships.
Maram Alkhdour indicated no relevant financial relationships.
Mubarak Yusuf indicated no relevant financial relationships.
Yasir Saeed indicated no relevant financial relationships.
Afsheen Afzal indicated no relevant financial relationships.


Mohammad Aldiabat, MD, Maram Alkhdour, MD, Mubarak Yusuf, MD, Yasir Saeed, MD, Afsheen Afzal, MD. P1885 - A Rare Case of Acute Decompensated Liver Failure in a Patient With Marchiafava Bignami Disease Associated With Poor Outcome, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.