Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Case Report

Volume 4, Number 4, August 2011, pages 168-173

A Case of Hypereosinophilia-Associated Multiple Mass Lesions of Liver Showing Non-Granulomatous Eosinophilic Hepatic Necrosis

Figures

Figure 1.
Figure 1. Radiological findings of the liver. (a) Enhanced CT of delayed phase. Multiple low density areas are detected in the whole liver. The lesions show nodular or geographic, and no enhanced effects. (b, c) MRI images. These lesions are iso or low intensity in T1-weight image (b), and iso or hyper intensity in T2-weight image (c).
Figure 2.
Figure 2. Histological findings of the liver needle biopsy. (a) The foci of eosinophil’s aggregates and hepatocyte’s dropouts are seen in liver parenchyma (surrounded by head of arrow). (HE, original magnification, x100). (b) The border of the eosinophile’s aggregates are relatively clear and cellular atypia of eosinophile are not apparent. (HE, original magnification, x400). (c) Asterisk areas are composed necrotic cells (HE, original magnification, x100). (d) (d) is high magnification of the asterisk area of (c). Charcot-Leyden crystals are scattered in necrotic area, which show lightly eosinophilic and bipyramidal or hexagonal in shape on sections. (HE, original magnification, x1000).

Tables

Table 1. Laboratory Data at Admission (Normal Range)
 
ItemValueItemValue
ALT, alanine aminotransferase; ALP, alkaline phosphatase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; CA19-9, Carbohydrate antigen 19-9; CRP, C-reactive protein; ECP, Eosinophil cationic protein; γ-GTP, gamma-glutamyl transpeptidase; HBsAg; hepatitis B surface antibody, HCV-Ab; hepatitis C virus antibody, IgE, immunoglobulin E; IL-4, interleukin-4; IL-5, interleukin-5; IL-6, interleukin-6; LDH, lactate dehydrogenase; PIVKA-II, protein induced by vitamin K absence or antagonist-II; Plt, platelet; RBC, red blood cell; sIL-2R, soluble interleukin-2 receptor; WBC, white blood cell.
RBC452 × 104 /µl (390 - 520 × 104 /µl)LDH654 IU/l (110 - 220 IU/l)
WBC213 × 102 /µl (33 - 90 × 102 /µl)CRP2.7 mg/dl (< 0.3 mg/dl)
Eosinophil62% (1-5%)IgE RIST1457.2 IU/ml (< 400 IU/ml)
Platelet17.3 × 104 /µl (15 - 35 × 104 /µl)ECP33.0 µg/l (< 14.7 µg/l)
AST110 IU/l (12 - 36 IU/l)IL-4(-) (< 15 pg/ml)
ALT108 IU/l (3 - 32 IU/l)IL-5(-) (< 8 pg/ml)
ALP499 IU/l (114 - 394 IU/l)IL-6(-) (< 8 pg/ml)
γ-GTP64 IU/l (9 - 71 IU/l)sIL-2R4483 U/ml (190 - 650 U/ml)
Total bilirubin0.57 mg/dl (0.1 - 1.0 mg/dl)DUPAN-2273 U/ml (< 150 U/ml)
Total protein6.1 g/dl (6.5 - 8.0 g/dl)PIVKA-II14 mAU/ml (< 40 mAU/ml)
Amylase116 IU/l (58 - 166 IU/l)CA19-9(-) (< 37 U/ml)
Creatinine0.75 mg/dl (0.6 - 1.2 mg/dl)HBsAg(-)
BUN13.7 mg/dl (10 - 20 mg/dl)HCV-Ab(-)

 

Table 2. Reviewer of the Cases Reported as HES
 
CaseAgeSexClinical findingRadiological findingPathological findingEffective therapyAssociated abnormalityReference
AMA, anti-mitochondrial antibody; ANA, anti-nuclear antibody; F, female; FIP1L1, FIP1-like 1 gene; M, male; NRH, nodular regenerative hyperplasia; NS, not stated; PDGFRA, platelet derived growth factor receptor α; PSC, primary sclerosing cholangitis; UC, ulcerative colitis.
128MAbdominal cramps, diarrhea, jaundiceDiffuse narrowing and strictures of biliary system (PSC-compatible)Cholangitis with eosinpophilic infiltration (PSC-like)Steroid hydroxyureaColitis with eosinophilic infiltrationScheurlen et al [16]
241MAbdominal pain, fever, jaundiceStricture and dilatation in extrahepatic bile duct (PSC-compatible)Eosinophilic sclerosing cholangitisSteroidGrauer et al [6]
358MJaundice, fatigue, abdominal painNormalEosinophilic cholangitisSteroidDillon et al [17]
420MJaundice, feverHepatomegaly, diffuse irregular appearance (PSC-like)Eosinophilic cholangitisSteroid, aminosalicylic acid (5-ASA)Colitis with eosinophilic infiltration (UC-like)Schoonbroodt et al [18]
552MDiarrhea, jaundiceNSEosinophilic cholangitisNSColitis with eosinophilic infiltrationSussman et al [19]
620MFatigue, myalgia, night sweatNSChronic active hepatitis with eosinophilic infiltrationSteroidAMA (NS)
ANA (+)		Croffy et al [20]
734MNausea, jaundiceNSChronic active hepatitis with eosinophilic infiltrationSteroidAMA (NS)
ANA (-)		Croffy et al [20]
819MJaundice, pruritic rashHepatomegalyChronic active hepatitis with eosinophilic infiltrationSteroidAMA (-)
ANA (-)		Foong et al [7]
965FArthralgiasNormalChronic hepatitis with confluent eosinophilic centrilobular necrosisSteroidAMA (+), ANA (-)Ung et al [21]
1052MMalaise, nausea, dizziness, weight lossHepatomegalyNRH, portal eosinophilic infiltrationSteroid, hydroxyurea, thiaguanineEsophageal varixBennie et al [9]
1127MAbdominal fullnessObstruction of the hepatic veins and stricture of the inferior vena cava (Budd-Chiari syndrome)Obstructive thrombophlebitis with eiosinophilic infiltrationInterventinal therapy, steroidFusion of the FIP1L1 and PDGFRA gene (+)Inoue et al [8]
1252FAbdominal painLiver massesHepatic eosinophilic infiltrationSteroidLai et al [22]
1370MBack pain, feverLiver massesHepatic eosinophilic infiltrationSteroidOur case