CRYPTOGENIC DECOMPENSATED CHRONIC LIVER DISEASE COMPLICATED BY HEPATOCELLULAR CARCINOMA: A CHALLENGING CASE REPORT

A Case Report

Abstract

Background: Cryptogenic cirrhosis represents a form of chronic liver disease (CLD) in which no definite etiology can be identified despite comprehensive clinical, serological, and histopathological evaluation. It is increasingly recognized as a potential risk factor for hepatocellular carcinoma (HCC), posing diagnostic and management challenges.

Case Presentation: We report the case of a 70-year-old non-alcoholic male with a known history of chronic liver disease complicated by portal vein thrombosis. The patient presented with progressive abdominal distension, right hypochondrial pain, and anorexia. Clinical examination revealed icterus, hepatosplenomegaly, and bilateral pitting edema. Laboratory investigations demonstrated elevated liver enzymes, hyperbilirubinemia, hypoalbuminemia, prolonged prothrombin time, and markedly raised alpha-fetoprotein (>1000 ng/mL). Imaging findings were suggestive of chronic liver disease with multiple hepatic lesions consistent with hepatocellular carcinoma. Liver biopsy confirmed micronodular cirrhosis without identifiable etiology, establishing a diagnosis of cryptogenic cirrhosis.

Conclusion: Cryptogenic cirrhosis complicated by hepatocellular carcinoma represents a complex clinical entity requiring thorough evaluation and multidisciplinary management. Early recognition and appropriate surveillance are essential to improve patient outcomes.