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Eosinophil-induced chronic hepatitis
1Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea.
Insights
A rare case of chronic hepatitis with hypereosinophilia in an infant was linked to parasitic infection. Anthelmintic treatment improved liver function and eosinophil counts but not cardiopulmonary symptoms.
Area of Science:
- Hepatology
- Pediatrics
- Parasitology
Background:
- Chronic hepatitis with hypereosinophilia is exceptionally rare.
- Infantile presentations are seldom documented, posing diagnostic challenges.
Observation:
- A 7-month-old male infant presented with fever, cough, vomiting, and hepatomegaly.
- Peripheral blood eosinophil count reached 21,500/mm3 (49% of WBC).
- History of contact with a pigsty suggested potential parasitic exposure.
Findings:
- Liver pathology revealed severe porto-periportal necroinflammation with marked eosinophilic infiltration, giant cell transformation, and hepatocyte ballooning.
- Bone marrow showed eosinophilia and a decreased myeloid series.
- Echocardiography revealed pericardial effusion and bilateral pulmonary consolidation.
Implications:
- Corticosteroid therapy exacerbated symptoms, indicating a non-allergic or adverse reaction.
- Anthelmintic treatment effectively normalized eosinophil counts and liver enzymes.
- Persistent cardiopulmonary manifestations highlight the potential for severe, long-term sequelae from parasitic infections in infants.
Abstract:
Chronic hepatitis associated with hypereosinophilia has been very rarely reported worldwide. A 7-month-old male infant presented with a high fever, cough, non-projectile vomiting and hepatomegaly. The eosinophil count of the peripheral blood increased up to 21,500/mm3 (49% of WBC). The infant had a history of frequent contact with a neighbor keeping a pigsty. The pathologic examinations of the liver showed severe porto-periportal necroinflammation with marked eosinophilic infiltration, giant cell transformation and ballooning degeneration of hepatocytes, and degranulation of the eosinophils. Bone marrow showed increased eosinophils and decreased myeloid series. Pericardial effusion and bilateral pulmonary consolidation were noted. Corticosteroid aggravated the clinical symptoms of the infant. Anthelmintic treatment significantly normalized the eosinophil count and liver function tests, but cardiopulmonary manifestations continued.