PMC4712424_01
(A) High-resolution computed tomography (CT) images showing multifocal patchy consolidation and nodular infiltration on both lower lungs. (B) Chest CT of enlarged paratracheal lymph node (arrowheads). (C, D) Magnetic resonance cholangiogram (non-contrast-enhanced) on (C) axial T2-weighted image and (D) axial T1-weighted image. Multiple gallbladder stones with a diffuse wall thickening and pericholecystic fluid collection.
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The chest computed tomography (CT) showed multiple lymphadenopathy at the right supraclavicular region, both hilar areas, and the mediastinum with multifocal pneumonic consolidations on both lower lungs (Fig. 1A and 1B). Abdominal sonography and magnetic resonance cholangiopancreatography revealed acute cholecystitis with multiple gall bladder stones and fatty liver (Fig. 1C and 1D).
Change in eosinophil counts during follow-up. The patient's manifestations are shown. GB, gallbladder; LN, lymph node.
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However, peripheral eosinophilia did not decrease (Fig. 2). Blood tests performed at subsequent outpatient department clinic visits indicated that the white blood cell count was 18,700/mm3 and eosinophils decreased to 22.3% (Fig. 2).
(A) Histopathological examination of a lung sample revealed necrotizing and granulomatous vasculitis with eosinophils, and multiple foci of intraluminal plugs of fibroblastic proliferation simulating bronchiolitis obliterans with organizing pneumonia (H&E, x200). (B) Histopathological examination of the right mediastinal lymph node sample revealed a high degree of eosinophilic infiltration (H&E, x200). (C) Histopathological examination of the gallbladder sample demonstrated necrotizing and granulomatous vasculitis with eosinophilic infiltration (H&E, x200).
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Histopathological examination of the resected GB, lung and LN showed necrotizing and granulomatous vasculitis with eosinophil infiltrates indicating CSS involvement, respectively (Fig. 3).