Dots on the Skin, Dots on the Liver

Abstract

Rare case of peliosis hepatis found in AIDS patient on abdominal MRI. Brings together GI, Radiology and ID 57 year old with hx of HSV, HIV/AIDS (CD4 count of 55, with VL of 115,000-non-compliant with HAART) and h/o recurrent skin lesions (boils-MRSA) admitted to hospital admitted for new abscess draining pus in left groin. Found to have incidental finding of liver lesions on CT scan. Patient denies any history of weight loss, change in appetite, diarrhea, abdominal pain, constipation, jaundice, hematemesis, melena or vomiting. Also denies any history of alcohol abuse or recent travel. Abdominal exam was unremarkable; physical exam positive for LUE and left groin abscess. The CT scan showed multiple hyper-enhancing lesions in the liver, greater in the right lobe, however a few lesions also present in the left lobe. Multiple brightly enhancing lesions are seen in the liver. These lesions may represent benign lesions such as hemangiomas or focal nodular hyperplasia, however are incompletely characterized on this study. Given the CT was non-specific (Image 1), an abdominal MRI (Image 2 and 3) was ordered showing Innumerable round intraparenchymal liver lesions. In the setting of HIV/AIDS, the radiologist felt these lesions represented peliosis hepatis. Patient remained asymptomatic (in terms of GI complaints). Given his cutaneous abscesses (which tested positive for MRSA) and AIDS, Bartonella serologies were sent off (came back negative). Patient will follow in 6-12 months to assess for regression of disease. Given our patient was asymptomatic, we decided to have serial follow up with radiological images but if the lesions were localized, surgery could have been considered. Also in many cases if a drug is presumed to be the cause of PH, then once the factor is removed the lesions can regress.1 Otherwise in rare cases the disease continues to progress to the point of liver failure at which point transplant is the only option.1 In our patient's case when looking back, given his AIDS, patient would have benefitted from further diagnostic testing for bartonella (given it is easily treatable with antibiotics) instead of just with serology (often inaccurate in immunosuppressed patients).2356_A Figure 1 No Caption available.2356_B Figure 2 No Caption available.2356_C Figure 3 No Caption available.