Background: Despite recent advances in management of acute liver failure (ALF), morbidity and mortality are still significantly high. Management strategies amongst others involve determination of etiology and greater than 50% of cases often require liver transplantation. Case presentation: A 36-year old Cameroonian male presented to our facility (a tertiary level health institution in Cameroon) with 10 days history of gastrointestinal symptoms (diarrhea, abdominal pain, and vomiting) for which he auto-medicated with herbs and intravenous cefriaxone for 3 days. Two days prior to the presentation he developed yellowish discoloration of the eyes which prompted consultation. His evolution inpatient was marked by development of ALF Lack of necessary diagnostic tools and intensive care unit substandard care led to worsening of ALF. The patient died on day 6 of hospitalization. Conclusion: The case presented brings to lamp light the difficulties encountered in making an aetiologic diagnosis for ALF and the substandard care provided in patients with ALF in resource-limited settings. A lot still needs to be done to empower facilities in developing nations in care of ALF.

Keywords: acute liver failure, diagnosis, management, pitfalls, case report.