We report one case of urothelial carcinoma with diffuse intrasinusoidal metastasis to the liver and clinical presentation mimicking fulminant hepatic failure. The patient was a 69-year-old man admitted to the hospital for upper gastrointestinal hemorrhage. Two years previously he had undergone a right nephrectomy for urothelial carcinoma (T2, GII). After five days of hospital admission, he developed progressive jaundice, ascites, deteriorating mental status with high serum enzyme activities (AST, ALT, LDH, alkaline phosphatase) and death 20 days after hospitalization. No grossly detectable hepatic metastatic nodules were demonstrated. A percutaneous postmortem liver biopsy revealed a diffuse infiltration of tumor cells into the hepatic sinusoids and venous invasion.