Focal Liver Lesions in a Child with Idiopathic Hypereosinophilic Syndrome: an Unusual Finding

Abstract

IntroductionIdiopathic hypereosinophilic syndrome (IHES) is characterized by the triad of peripheral blood eosinophilia (>1500 cells/μl) for more than 6 months, without any other discernible cause of eosinophilia in association with signs and symptoms of organ in ltration related to eosinophili. IHES is usually seen in the middle age group of 20-50 years and is uncommon in the pediatric population. Various organ systems can be involved and about 30% of patients have hepatic involvement which can manifest as chronic active hepatitis, eosinophilic cholangitis, focal hepatic lesions, or Budd Chiari syndrome. Hepatic involvement is infrequent in IHES, which can manifest as either hepatitis, focal parenchymal lesions, or Budd Chiari syndromeFocal lesions in the liver are often misinterpreted as infective lesions,however, correlation with chest ndings can help in making the diagnosis Case presentationHerein, we report a case of a 12-year-old male child with IHES who had multisystem involvement (hepatic, pulmonary, and cardiac). The child showed symptomatic, biochemical as well as radiological improvement with steroid therapy on follow-up. ConclusionFocal liver lesions mimic infective or benign lesions. It is essential to diagnose these lesions to obviate unnecessary biopsies, especially in children. The mainstay of treatment in these patients is corticosteroids in contrast to infective lesions where antibiotics are given.The response can be assessed by resolution of liver and pulmonary lesions and reduced eosinophil counts.