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JAMA Surgery Clinical Challenge
June 2018

Multiple Liver Lesions in a Woman With Asthenia, Anorexia, and Fever

Author Affiliations
  • 1Department of Hepatobiliary Surgery, China-Japan Friendship Hospital, Beijing, China
JAMA Surg. 2018;153(6):592-593. doi:10.1001/jamasurg.2018.0595

A woman in her early 50s with a history of hepatitis B was admitted to our hospital. She complained of asthenia, anorexia, and intermittent fever during the past 6 months. The patient’s highest temperature was 39°C, and her fever could be treated by antifebrile drugs. Physical examination at admission showed no positive signs of the symptoms. Ultrasonographic examination revealed multiple lesions in the liver, suggestive of liver metastases. Positron emission tomography/computed tomography showed abnormally intense and high metabolic activity in all of the liver lesions, and the maximum standardized uptake value was 12.1. Laboratory testing of blood samples, fecal occult blood tests, liver function tests, and tests for alpha fetoprotein, carcinoembryonic antigen, and carbohydrate antigen 19-9 had normal results. The patient’s erythrocyte sedimentation rate was 84 mm/h (reference range, 0-20 mm/h). Test results were positive for hepatitis B surface antigen, hepatitis B e antibody, and hepatitis B c antibody. Treponema pallidum particle agglutination test results indicated a signal to cutoff ratio of 41.72 (reference range, 0-1), and the results of an enzyme-linked immunospot test for tuberculosis (T-SPOT.TB; Oxford Immunotec) were negative. Abdominal contrast-enhanced computed tomography was performed (Figure 1).

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