Multiple Low-Density Areas in the Liver

Abstract

Question: A 57-year-old man was transferred to our hospital because of hypereosinophilia, skin eruption on his lower leg, and liver dysfunction while hospitalized for status asthmaticus in another hospital. Furthermore, he complained of paresthesia and myalgia of the extremities during further investigation in our hospital. Laboratory analysis revealed an elevated white blood cell count of 23,200/mm 3 and hypereosinophilia (70.0%). Cholestatic liver dysfunction tests showed the following results: aspartate transaminase (51 U/L), alanine aminotransferase (106 U/L), lactate dehydrogenase (262 U/L), alkaline phosphatase (736 U/L), and gglutamyl transferase (117 U/ L). Hepatitis B surface antigen and hepatitis C virus RNA test results were negative. Antinuclear antibody, antimitochondrial antibody, myeloperoxydase anti-neutrophil cytoplasmic antigen, and proteinase-3 anti-neutrophil cytoplasmic antigen were normal. Transbronchial lung biopsy and skin biopsy showed no pathological significance. An enhanced abdominal computed tomography (CT) scan was performed (Figure A; enlarged view in 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.