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

Abstract

Hypereosinophilic syndrome (HES) is defined by elevation more than 1.5×109/L of presence of a peripheral blood count, evidence of organ involvement, and exclusion of secondary eosinophilia such as allergic, vasculitis, drugs, or parasite infection and also clonal eosinophilia. We present the HES case with hepatic involvement. The patient is 70-year-old male. He complained fever and back pain. Blood examination showed marked peripheral eosinophilia, elevation of transaminase and biliary enzymes. Multiple irregular mass lesions of the liver were pointed out by CT and MRI. The liver biopsy was done for differentiation from malignancy. In parenchyma, hepatic necrotic lesion was observed accompanying severe eosinophilic infiltration with Charcot-Leyden’s crystals. There was granulomatous reaction. He was diagnosed as HES and got recovery due to steroid therapy. From the review of HES article, the hepatic histology is categorized into four types as below: 1) cholangitis type; 2) chronic active hepatitis type; 3) vasculopathic type, 4) hepatic necrosis type. Our case is classified in hepatic necrosis type. This type seems to be important to distinguish malignant tumor and also visceral larva migrans by liver biopsy.

Eosinophilic Liver Abcesses and Pyrexia of Unknown Origin in Idiopathic Hypereosinphilic Syndrome: Myeloproliferative or Mimic?

“…HES presenting as isolated hepatic eosinophilic abscesses is rare. [8,9] The radiological appearance of the eosinophilic abscesses resembled hepatic metastases, which was another unusual finding in our case. [10] HES is an uncommon differential diagnosis in a case of PUO with eosinophilia.…”

Charcot-Leyden Crystals in Eosinophilic Inflammation: Active Cytolysis Leads to Crystal Formation

“…As early as 1947, Samter stated that "numerous observations have established the relation between the presence of disintegrating eosinophilic leukocytes and Charcot-Leyden crystals" [2]. CLCs have been repeatedly described in association with "necrotic" or "damaged" cells ( [21][22][23][24][25], Table 1). In addition, the presence of CLCs in nasal polyps from patients with eosinophilic chronic rhinosinusitis was associated with disease severity [26••].…”

Hypereosinophilia‐related liver pseudotumor with elevated interleukin‐5 levels preceding T‐cell lymphoma

“…Consequently, we interpreted the eosinophilic liver mass to be a manifestation of hypereosinophilic syndrome. After the liver biopsy, hypereosinophilia was treated by oral administration of prednisolone at an initial dose of 60 mg/day . Two weeks later, a follow‐up contrast‐enhanced CT confirmed that almost all the previously detected tumors had disappeared (Fig.…”

“…Hypereosinophilia can lead to pseudotumors in the liver, most of which are treated by prednisolone. 1 We report a rare case of hypereosinophilia-related liver pseudotumor presumed by the elevation of interleukin (IL)-5, which was produced by T-cell lymphoma detected 10 months after detection of the pseudotumor in the liver.…”