Presentation
Presented with 6weeks tiredness and generalised itching , rash on trunk and back. Deranged Liver function tests GGT 1839.4, LDH 286, ALT 432 and bilirubin 12.
Patient Data
The liver appeared slightly enlarged with a mildly irregular outline, multiple small avascular, hypoechoic lesions demonstrated throughout the liver parenchyma.
The liver is enlarged and shows heterogeneous enhancements with mild surface irregularity. An Ill-defined hypodense lesion measuring approximately 27x25 mm was seen in segment 2 of the liver, causing mild compression on the left hepatic vein.
The spleen is enlarged in size and measures approximately 13.8cm; a small ill-defined hypodensity is seen in the lower polar region.
Impression: hepatosplenomegaly with mild surface irregularity of liver and multiple ill-defined hypodensities in liver parenchyma and a small hypodensity in the spleen.
Case Discussion
This is quite an interesting case which presented with only 6weeks of history of tiredness and generalised itching; there were no fever or obstructive jaundice symptoms.
A substantial differential would be Autoimmune hepatitis, as both are considered autoimmune diseases of the liver; however, histological appearances could provide us with more clarity. Primary biliary cholangitis shows bile duct destruction (sometimes with granulomas), and autoimmune hepatitis shows prominent portal and lobular lymphoplasmacytic inflammation.
Laboratory test
Antimitochondrial antibodies were negative, anti-smooth muscle antibodies and liver/kidney microsomes antibodies were negative.
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