PMC8758446_01
Abdominal CT images at referral to our division. Multiple spherical hepatic nodules, ranging in size from 1-3 cm, are distributed in both liver lobes (A-D, arrows). The nodules showed two types: those with well-defined borders (A, C) and those with ill-defined borders (B, D). The nodules had no capsular structure and very weak contrast enhancement.
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Abdominal contrast-enhanced CT showed multiple spherical hepatic nodules, ranging in size from 1-3 cm (Fig. 1). The nodules included two types: ones with well-defined borders (Fig. 1A, C) and ones with ill-defined borders (Fig. 1B, D).
Abdominal ultrasound images. Multiple spherical nodules corresponding to the nodules on CT are detected. The nodules showed two types: those with well-defined borders (A, B; arrows) and those with ill-defined borders (C, D; arrows).
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On ultrasound imaging, multiple spherical nodules were detected, corresponding to the nodules on the CT (Fig. 2).
Abdominal MRI findings at referral to our division. (A) T1-weighted image, (B) T1 early phase, (C) T1 portal phase, (D) T1 late phase, (E) T1 hepatocyte phase, (F) T2-weighted image, (G) diffusion-weighted image. The hepatic nodules have a low signal intensity on T1 imaging with very weak contrast enhancement and slightly high signal intensity on T2 imaging. The nodules are distinguished clearly on diffusion-weighted imaging.
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T1 and slightly high signal intensity on T2 and were distinguished clearly on diffusion-weighted imaging (Fig. 3). The nodules showed no hepatic uptake of the contrast agent in the hepatocyte phase of a gadolinium-EOB-DTPA contrast study, consisting of well- and ill-defined nodules (Fig. 4).
Abdominal MRI findings in the hepatocyte phase. The nodules lack a hepatic uptake of the contrast agent in the hepatocyte phase of a gadolinium-EOB-DTPA contrast study, consisting of well-defined and ill-defined nodules.
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T1 and slightly high signal intensity on T2 and were distinguished clearly on diffusion-weighted imaging (Fig. 3). The nodules showed no hepatic uptake of the contrast agent in the hepatocyte phase of a gadolinium-EOB-DTPA contrast study, consisting of well- and ill-defined nodules (Fig. 4).
Pathological images of a nodule in the medial segment. (A) A low-magnification image with Hematoxylin and Eosin (H&E) staining. (B) A high-magnification image with H&E staining. (C) A high-magnification image with direct fast scarlet staining.
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The biopsy showed marked aggregation of immune cells in the nodule (Fig. 5A, B). The immune cells were identified as eosinophils, containing eosinophilic granules in the cytoplasm by direct fast scarlet staining (Fig. 5C).
Clinical course. Serum alanine aminotransferase (ALT) levels, white blood cell count, and eosinophil count in peripheral blood.
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After discontinuing G. lucidum, the peripheral eosinophil count and ALT level rapidly decreased (Fig. 6).