“Malignant” Liver Cysts Cause Liver Failure and Recurrence

Abstract

Question: A 38year-old man presented with a history of progressive jaundice and multiple intrahepatic cystic round-shaped lesions for about 3 years. He had no viral or autoimmune hepatitis, but a habit of eating raw seafood. Suspecting a parasitic infection, the patient received an anthelmintic therapy, which showed no effect. Later, the patient returned with more severe jaundice and more lesions on computed tomography images (Figure A).Laboratory tests showed the following results: alanine aminotransferase level of 26 U/L, aspartate aminotransferase level of 62 U/L, alkaline phosphatase level of 374 U/L, a bilirubin level of 36.1mg/dL, an albumin level of 3.4 g/dL, and an international normalized ratio of 1.09. In addition, there was no evidence of malignancy or other organs involvement. The orthotopic liver transplantation was performed because of hyperbilirubinemia. The long-term immunosuppressive regimen postoperatively was tacrolimus (FK506, Prograf) monotherapy.Thirteen months later, a computed tomography scan showed some new cystic lesions in the liver (Figure B). A liver biopsy confirmed the recurrence of primary disease. Similar cystic lesions were found in the lungs as well (Figure B). What is the diagnosis?See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.