We present the case of a 62-year-old patient who developed dyspnoea, chest and dorsal pain. The history was taken, finds patients was smoker and has high blood pressure, chronic obstructive pulmonary disease and sleep apnea syndrome. So, the patients followed by Complementary tests (tomography, bronchoscopy and endoscopic ultrasound. he was diagnosed with lung adenocarcinoma stage IV (T4N3M1b bone and pulmonary lesions, no liver masses) without target driver. He was stared chemotherapy and immunotherapy in clinical trial with tumor response but liver failure. We performed a differential diagnosis to discern the etiology of the fulminant hepatitis.