Multifocal hepatic inflammatory pseudotumor: review

Inflammatory pseudotumor (IPT) is a rare benign lesion that can closely mimic malignant neoplasms both clinically and radiologically. Hepatic inflammatory pseudotumor (HIPT) is an uncommon manifestation, with fewer than 300 cases reported in the literature.

We present the case of a 67-year-old male with a three-week history of fever and weight loss, and constitutional symptoms. Evaluation with MRI showed multiple hepatic lesions, raising suspicion for metastatic disease or hepatic abscesses. A percutaneous liver biopsy was performed, and histopathological analysis demonstrated a lymphoplasmacytic-rich fibroinflammatory lesion with numerous IgG4-positive plasma cells, consistent with HIPT. The patient was managed conservatively with antibiotics, leading to full clinical recovery and complete radiological resolution after 10 months.

Multifocal HIPT poses a significant diagnostic challenge due to its radiologic similarity to hepatic malignancies. Liver biopsy remains critical for establishing an accurate diagnosis and preventing unnecessary surgical intervention.