What Are the Clinical Features and Etiology of Eosinophilic Liver Infiltration?

BACKGROUND/AIMS: Although eosinophilic liver infiltration (ELI) is not rare, few data exist regarding its clinical characteristics and etiology. Therefore, we evaluated these aspects to better understand the clinical implications of this lesion type, which is reasonably common in Korea. METHODS: Patients suspected of having ELI, based on abdominal computed tomography results obtained between January 2010 and September 2017, were enrolled in this retrospective study. The presumptive etiologies of ELI were categorized as parasite infections, hypereosinophilic syndrome (HES), eosinophilic granulomatosis with polyangiitis (EGPA), malignancies, and unidentified. Clinical courses and treatment responses were also evaluated. RESULTS: The mean age of the enrolled patients (male, 237/328) was 62 years. Most patients (63%) were diagnosed incidentally and had peripheral eosinophilia (90%). Only 38% of the enrolled patients (n=126) underwent further evaluations to elucidate the etiology of the suspected ELI; 82 (25%) had parasite infections, 31 (9%) had HES, five (2%) had EGPA, and five (2%) had drug reactions in conjunction with eosinophilia and systemic symptoms. Almost half of the other enrolled patients had cancer. Radiologic resolution was achieved in 191 patients (61%; median time to radiologic resolution, 185 days). Resolution of peripheral eosinophilia was achieved in 220 patients (79%). In most cases, the course of ELI was benign. CONCLUSIONS: This large ELI study is unique in that the incidence rate, underlying diseases, and clinical courses were comprehensively evaluated. Clinicians should investigate the etiology of ELI, as several of the underlying diseases require intervention rather than observation.

Remission of secondary membranous nephropathy in a patient with Kimura disease after surgical resection

Kimura disease (KD) is an eosinophilic, granulomatous, benign, chronic inflammatory disease with an unknown etiology. A 33-year-old woman visited our hospital because of a palpable, left subclavian mass, a left scapulo-anterior pseudoaneurysm, and nephrotic syndrome. Her subclavian lymph node biopsy examination result was consistent with KD, and results of a renal biopsy indicated secondary membranous nephropathy. After renal histological examination confirmed nephropathy, treatment with prednisolone and cyclosporine was initiated, which was maintained for over 1 year. However, this therapy only provided a transient improvement in proteinuria. One year after commencing the treatment, both proteinuria and azotemia aggravated as the left axillary mass doubled in size. Finally, the mass was surgically excised, following which the azotemia rapidly normalized and proteinuria resolved within 1 month. This case shows that tumor resection in a patient with KD with secondary nephropathy may resolve secondary renal manifestations. Furthermore, reversible renal dysfunction may be caused by unknown secreted molecules.

Differentiating Focal Eosinophilic Infiltration from Metastasis in the Liver with Gadoxetic Acid-Enhanced Magnetic Resonance Imaging

OBJECTIVE: To determine the most useful findings of gadoxetic acid-enhanced 3.0 Tesla (T) MRI for differentiating focal eosinophilic infiltration (FEI) from hepatic metastasis with verification of their usefulness. MATERIALS AND METHODS: Pathologically or clinically proven 39 FEIs from 25 patients and 79 hepatic metastases from 51 patients were included in the study. Gadoxetic acid-enhanced 3.0T MRI was performed in all cancer patients. Size differences measured between T2-weighted and hepatobiliary-phase images for lesions > 1 cm and morphologic findings (margin, shape, signal intensity on T1- and T2-weighted images, enhancement pattern on dynamic images, and target appearance on hepatobiliary-phase images) were compared between two groups via Student's t test as well as univariate and multivariate analyses. Diagnostic predictive values of two observers for differentiating two groups were assessed before (session 1) and after (session 2) recognition of results. RESULTS: Mean size difference (2.1 mm) in FEIs between the two images was significantly greater than for metastases (0.7 mm) (p < 0.05). An ill-defined margin and isointensity on T1-weighted images were independently significant morphologic findings (p < 0.05) for differentiating the two groups. All observers achieved a higher diagnostic accuracy in session 2 (97% and 98%) than session 1 (92% and 89%) with statistical significance in observer 2 (p < 0.05). All observers had significantly higher sensitivities (95%) and negative predictive values (NPVs) (98%) in session 2 than in session 1 (sensitivity, 74% in two observers; NPV, 89% and 88%) (p < 0.05). CONCLUSION: With the size change, an ill-defined margin and isointensity on T1-weighted images are the most useful findings for differentiating FEI from hepatic metastasis on gadoxetic acid-enhanced 3.0T MRI.

A Case of Churg-Strauss Syndrome with Interstinal Perforation / 결핵및호흡기질환

Churg-Strauss syndrome (CSS) or allergic granulomatous angiitis is a rare syndrome that is characterized by hypereosinophilic systemic necrotizing vasculitis affecting small- to medium-sized arteries and veins. In general, it occurs in individuals with pre-existing allergic asthma. When CSS appears in patients, it has the following characteristics: eosinophilia of more than 10% in peripheral blood, paranasal sinusitis, pulmonary infiltrates, histological proof of vasculitis with extravascular eosinophils, and mononeuritis multiplex or polyneuropathy. Therapeutic trials dedicated to Churg-Strauss syndrome have been limited due to the rarity of this disorder and the difficulty in making a histological diagnosis. Proper treatment of patients with CSS is not widely known. In this case study, we report on our experience with an unusual patient case, characterized by purpura and a perforation of the small intestine after inadequate steroid therapy.

Unusual Eosinophilic Infiltration of the Skin in a Patient with Precedent Kimura's Disease

A 25 year old man presinted with erythematous and inderated plaques on the upper and lower extermities that were preceded by insect bites while traveling in central Africa. The patient had a past histrory of Kimura's disease, asthma, and allergic rhinitis, Histologic examination revealed panniculitls showing massive eosinophilic infiltration. The dermis showed eosinopbilic infilreatiom without flame figyres. The patient responded well to oral conrticosteroids. This patient did not fit the diagnosis of eosinoplilic pannicylitis, eosinophilic cellylitis, hypereosinophilic syndrome or eosinophilic vascylitis.