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A rare cause of a focal liver lesion.

Gastroenterology 2014;147:e14–e15 Question: A 41year-old woman was referred to our hospital for evaluating the cause of a large space occupying lesion in liver detected on ultrasonography and contrastenhanced computed tomography (CT). Her medical history included dull pain in upper abdomen of 15 days’ duration and loss of appetite and weight. She denied history of fever, trauma to the abdomen, or jaundice. She has been on venalafexine for the treatment of depression. Her physical examination showed mild pallor and significant hepatomegaly (liver span of 16 cm). Laboratory tests revealed total leucocyte count (29,000/mL) and absolute eosinophilia of 1,900/mL,with normal liver and renal function tests. Tumor markers including alpha-fetoprotein, CA 19-9, carcinoembryonic antigen, and CA-125 were within normal limits. CT showed 6.3 4.6 4.9-cm, hypodense, hypovascular lesion with ill-defined margins in segment 1V with extension into segments II and III. In addition, there were multiple, small, ill-defined, hypovascular, hypodense lesions in both lobes of liver (Figure A). Hepatic vessels were seen traversing through these areas. Upper gastrointestinal endoscopy did not show any varices or evidence of portal hypertension. Liver biopsy, bone marrow aspiration/biopsy, and stomach biopsy showed eosinophilic infiltrates (Figure B–D). What is the most likely diagnosis? See the Gastroenterology web site (www.gastrojournal.org) for more information on submitting your favorite image to Clinical Challenges and Images in GI.