PMC6911765_01
A: Chest X ray showing a nodular shadow in the left upper lung field. B: Thoracic CT showing a nodular shadow with spicula in the left upper lobe. C: Enhanced abdominal CT showing splenomegaly and a normal bile duct, gallbladder and liver.
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On admission, chest X-ray showed a nodular shadow in the left upper lung field (Fig. 1A). Thoracic computed tomography revealed a 2.6x3.0 cm nodular shadow in the left upper lobe (Fig. 1B). Splenomegaly was detected on enhanced abdominal computed tomography (CT), although dilatation of the bile duct and thickening of the gallbladder wall were not observed (Fig. 1C).
A, B: Histopathology of the liver showing infiltration due to inflammatory cells in the portal tract (white arrow) and destruction of the interlobular bile duct (yellow arrow), while the parenchyma and centrilobular zone showed a normal architecture (A: Hematoxylin and Eosin staining x100, B: x400). C: Immunohistochemical staining showing that infiltration due to inflammatory cells is by CD8+lymphocytes (CD8 staining by monoclonal anti-human CD8 mouse antibodies x400).
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Histopathology of the liver revealed inflammatory cell infiltration of the portal tract and destruction of the interlobular bile duct, whereas the parenchyma displayed a normal architecture (Fig. 2A and B). Immunohistopathological staining showed that those inflammatory cells were represented by CD8+ lymphocytes (Fig. 2C).
Serum alanine transaminase (ALP) and gamma-glutamyl transpeptidase (gamma-GTP) did not improve after the administration of prednisolone 80 mg (1 mg/kg), while decreases in aspartate aminotransferase (AST), alanine transaminase (ALT) and total bilirubin (T-Bil) were observed. However, biliary tract enzymes were consequently improved after the administration of UDCA 900 mg daily was commenced.
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The administration of ursodeoxycholic acid (UDCA) 900 mg daily was commenced after a pathological finding was obtained, and biliary tract enzymes were consequently improved (Fig. 3).