Hepatitis C and Numerous Disappearing Hepatic Nodules: No-dule C It, No-dule Don’t

Abstract

Question: A 52-year-old Caucasian male with a past medical history of hypertension underwent evaluation for chronic, intermittent abdominal discomfort. He drank an average of 48 ounces of beer daily and had a remote history of intravenous drug use. He was referred to our center when a contrast-enhanced computed tomography (CT) scan of the abdomen, obtained during late arterial phase, showed numerous discrete hypoattenuating hepatic lesions concerning for malignancy (Figure A). Physical examination showed normal vital signs with a body mass index of 29 kg/m. There were blisters and erosions on the dorsum of his hands bilaterally with no lymphadenopathy, hepatosplenomegaly, or stigmata of chronic liver disease. Liver tests were mildly elevated and remaining basic bloodwork was within normal limits. Viral hepatitis studies demonstrated negative HIV, immunity to hepatitis B, with core antibody positivity, and hepatitis C antibody positivity with a subsequent viral load of 14 million and genotype 1a. Iron percent saturation was 54 with a ferritin of 1099 ng/mL; genetic testing showed heterozygosity for p.H63D. Tumor markers ɑ-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 were normal. Abdominal magnetic resonance imaging (MRI) with Multihance was completed on initial referral, demonstrating a noncirrhotic liver with no evidence of portal hypertension. In-phase and opposed-phase gradient echo T1-weighted MRI