A 75-year-old woman with a 50-pack-year history of tobacco abuse presented with abdominal pain, encephalopathy and elevated liver enzymes. Serologic evaluation for viral hepatitis, drug levels and chronic liver disease panel was negative. Computed tomography (CT) scan of the abdomen showed hepatomegaly and a large area of decreased attenuation in the lateral segment of the left lobe of the liver which was also demonstrated on the magnetic resonance cholangiopancreatography. CT of the chest was significant for a 1.4 cm left peripheral lingular nodule. Hepatic mass biopsy revealed small cell carcinoma (SCC), favoring lung primary. She had persistent liver failure with encephalopathy, coagulopathy and elevated liver enzymes during her hospital stay. Acute liver failure (ALF) is characterized by liver damage, encephalopathy and coagulopathy in patients without any prior history of liver disease. Although malignant infiltration has been described as a cause of ALF, SCC of the lung is an uncommon etiology.