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Virtual case of the month
Liver biopsy can be a tool for unravelling a rare diagnosis
  1. Monika Sharma1,
  2. Puja Sakhuja1,
  3. Swati Dublish2,
  4. Sugandha Saxena2,
  5. Anju Seth2
  1. 1 Pathology, GB Pant Hospital, New Delhi, India
  2. 2 Pediatrics, Lady Hardinge Medical College, New Delhi, India
  1. Correspondence to Professor Puja Sakhuja, Pathology, GB Pant Hospital, New Delhi 110002, India; pujasak{at}gmail.com

https://doi.org/10.1136/jclinpath-2020-206993

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    Clinical question

    A 5-year-old male child presented with fever, cough, wheeze, lung infiltrates, mild hepatomegaly and eosinophilia that was refractory to antibiotics and antihelminthics. He had no history of asthma, atopy, repeated respiratory/sinus infections, abdominal pain, diarrhoea or malabsorption. The complete blood count showed total leucocyte count of 47 800/mm3 with absolute eosinophil count of 23 150/mm3. Bone marrow examination showed absolute eosinophilia with microcytic hypochromic anaemia. The serum IgE level was 2816 IU/mL. On ELISA, C-ANCA (Antineutrophil cytoplasmic antibody) was mildly elevated (4 IU/mL) and P-ANCA was normal. In view of mild hepatomegaly on ultrasonography, liver biopsy was performed. The histology of the liver biopsy is shown (see figure 1).

    Figure 1

    Liver biopsy. (A) The portal tracts …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors MS contributed to concept, collection of data and drafting manuscript. PS contributed to concept, intellectual content and editing of manuscript. SD contributed to collection of clinical data. SS contributed to collection of clinical data. AS contributed to collection of clinical data.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.