Eosinophilic pseudotumour of the liver

Abstract

A 50-year-old woman presented with a 3-month illness with intermittent high-graded fever and significant weight loss. On admission, the physical examination revealed hepatomegaly with mild tenderness. Initial evaluation showed mild liver dysfunction and eosinophilia (1,900/ml). Abdominal ultrasonography revealed a 9-cm diameter hypoechoic lesion in the right hepatic lobe. Contrast-enhanced computed tomography demonstrated conglomerate hypodense lesions with lobulated surface and minimal peripheral enhancement at the inferior segment of the right hepatic lobe with subcapsular haemorrhage (arrow) (Fig. 1A). Enlarged lymph nodes were also observed in the porta hepatis. Subsequently, patient underwent percutaneous liver biopsy because the possibility of cystic neoplasm was not entirely excluded. Histological examination of the specimen showed necrotizing eosinophilic granulomas (Fig. 1B) with Charcot-Leyden crystals (arrows) in the absence of identifiable organisms and malignancy (Fig. 1C). Repeated examinations of stool specimens were negative for ova and parasites. The diagnosis of acute fascioliasis was established by a positive immunoserological test. Patient was a habitual consumer of watercress, which may explain the Fasciola hepatica infection. After therapy with a single dose of 10 mg/kg triclabendazole, patient had clinical improvement and disappearance of eosinophilia. One year later, she remained asymptomatic and liver imaging showed almost complete resolution of the lesions. Some clinical features of acute-stage fascioliasis can mimic tumours and is characterized by eosinophilia accompanied with eosinophilic-rich granulomatous lesions in an enlarged liver (1, 2). The identification of eosinophilic granulomatous hepatitis should suggest the diagnosis of visceral larva migrans and prompt a search for the causative organism with serologic tests for parasites (3).