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Case Reports
. 2021;60(24):3897-3903.
doi: 10.2169/internalmedicine.7431-21. Epub 2021 Dec 15.

Hypereosinophilia with Hepatic Nodule Formation Caused by Ganoderma lucidum

Takayuki Kogure  1 , Akinobu Koiwai  1 , Daisuke Fukushi  1 , Mari Satoh  1 , Keigo Murakami  2 , Morihisa Hirota  1 , Katsuya Endo  1 , Kazuhiro Murakami  2 , Kennichi Satoh  1
Affiliations
Case Reports

Hypereosinophilia with Hepatic Nodule Formation Caused by Ganoderma lucidum

Takayuki Kogure et al. Intern Med. 2021.

Abstract

A 61-year-old man who underwent surgery for rectal adenocarcinoma developed multiple hepatic nodules. The nodules were 1-3 cm without a capsular structure or contrast enhancement on computed tomography/magnetic resonance imaging, findings that were atypical for adenocarcinoma metastases. A biopsy showed the aggregation of eosinophils without larval bodies, ova, or granulomas. Laboratory tests showed a marked increase in eosinophils and a slight liver enzyme elevation. He had been taking the commercial herbal medicine Ganoderma lucidum for his liver function. After discontinuing G. lucidum, the eosinophil counts and liver enzyme levels rapidly resolved, and the nodules disappeared completely. This is a rare case of hypereosinophilia with hepatic nodules reactive to herbal medicine rather than a parasitic infection.

Keywords: Ganoderma lucidum; hepatic nodules; hypereosinophilia.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Abdominal CT images at referral to our division. Multiple spherical hepatic nodules, ranging in size from 1-3 cm, are distributed in both liver lobes (A-D, arrows). The nodules showed two types: those with well-defined borders (A, C) and those with ill-defined borders (B, D). The nodules had no capsular structure and very weak contrast enhancement.
Figure 2.
Figure 2.
Abdominal ultrasound images. Multiple spherical nodules corresponding to the nodules on CT are detected. The nodules showed two types: those with well-defined borders (A, B; arrows) and those with ill-defined borders (C, D; arrows).
Figure 3.
Figure 3.
Abdominal MRI findings at referral to our division. (A) T1-weighted image, (B) T1 early phase, (C) T1 portal phase, (D) T1 late phase, (E) T1 hepatocyte phase, (F) T2-weighted image, (G) diffusion-weighted image. The hepatic nodules have a low signal intensity on T1 imaging with very weak contrast enhancement and slightly high signal intensity on T2 imaging. The nodules are distinguished clearly on diffusion-weighted imaging.
Figure 4.
Figure 4.
Abdominal MRI findings in the hepatocyte phase. The nodules lack a hepatic uptake of the contrast agent in the hepatocyte phase of a gadolinium-EOB-DTPA contrast study, consisting of well-defined and ill-defined nodules.
Figure 5.
Figure 5.
Pathological images of a nodule in the medial segment. (A) A low-magnification image with Hematoxylin and Eosin (H&E) staining. (B) A high-magnification image with H&E staining. (C) A high-magnification image with direct fast scarlet staining.
Figure 6.
Figure 6.
Clinical course. Serum alanine aminotransferase (ALT) levels, white blood cell count, and eosinophil count in peripheral blood.
See this image and copyright information in PMC

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