title: Hepatitis associated with hypereosinophilia suspected to be caused by HES that also presented with the pathological features of IgG4-related disease.
abstract: A 52-year-old woman presented to our hospital due to elevated liver enzyme levels and hypereosinophilia. Liver biopsy specimens revealed chronic hepatitis with abundant eosinophils and immunoglobulin G4(IgG4)-positive plasma cell infiltration. Systemic lymphadenopathy, including that involving the hepatic hilar lymph nodes, was observed on computed tomography, and the cervical lymph node biopsy specimens exhibited lymphoid follicular hyperplasia and IgG4-positive plasma cell infiltration. It is sometimes difficult to distinguish hypereosinophilic syndrome (HES) from IgG4-related disease, as some of the clinical findings overlap. The numerous areas of eosinophilic infiltration observed in the liver indicated a diagnosis of HES in our case.
authors.affiliation: Department of Rheumatology and Allergy, Shimane Prefectural Central Hospital, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Nagamura
authors.forename: Sayaka
authors.initials: S
authors.lastname: Ueno
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Fujishiro
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Oonuma
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D019268:Antibodies, Antineutrophil Cytoplasmic / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D006521:Hepatitis, Chronic / Q000097:blood / Q000209:etiology* / Q000473:pathology; D006801:Humans; D006932:Hyperbilirubinemia / Q000209:etiology; D017681:Hypereosinophilic Syndrome / Q000150:complications* / Q000188:drug therapy; D007074:Immunoglobulin G / Q000097:blood*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D010265:Paraproteinemias / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D019268:Antibodies, Antineutrophil Cytoplasmic; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D011239:Prednisolone; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase