Question: A 50-year-old female with a history of several abortions developed a low-grade fever and nausea persisting for more than 3 months. No definitive diagnosis was made despite visiting several hospitals. Blood tests revealed a slightly elevated white blood cell count (9,820 cells/μL) and mild anemia (red blood cell count: 400 × 104 cells/μL; hemoglobin: 10.4 g/dL; hematocrit: 33.6%) with a normal platelet cell count. Biochemical analyses revealed marked elevations in γ-glutamyl transpeptidase (426 U/L; normal range [NR]: 9–32 U/L) and alkaline phosphatase ([ALP], 801 U/L; NR: 38–113U/L) levels; however, levels of liver transaminases and total bilirubin were normal. Hypoalbuminemia (2.6 g/dL; NR: 4.1–5.1 g/dL), accompanied by normal immunoglobulinemia, was detected. Coagulation and thyroid function tests were also normal. Viral markers for hepatitis B and C were negative. Viral antibody (Ab) responses against cytomegalovirus and Epstein-Barr virus were consistent with a past infection. Infection with SARS-CoV-2 and tuberculosis was excluded via polymerase chain reaction and the interferon-γ release assay, respectively. Antimitochondrial M2 Abs, antinuclear Abs, and cytoplasmic antineutrophil Abs against proteinase-3 or myeloperoxidase were negative. Serum C-reactive protein (CRP; 9.67 mg/dL; NR: 0–0.14) levels were elevated. Serum tumor marker levels, including alpha-fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9, were within normal ranges. Blood culture for pathogenic bacteria was negative. Initially, abdominal ultrasonography was performed to further investigate abnormalities in hepatobiliary enzymes. Hypo-echoic nodules with diameters of 14 mm and 9 mm were detected in the S3 and S4 of the liver, respectively (Figure A). In addition, swelling of the hepatic hilar and para-aortic lymph nodes (LNs) was detected (Figure B). Contrast-enhanced dynamic computed tomography (CT) revealed 3 nodules in the S3, S4, and S5 of the liver (Figure C). All of these liver nodules showed irregular enhancement at the arterial phases and round ring enhancement with central avascular areas at the portal phase, which is referred to as the bull’s-eye sign. Hepatomegaly was also seen via both abdominal ultrasonography and CT. No major abnormalities were seen in the pancreaticobiliary ducts during magnetic resonance cholangiopancreatography.