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Volume 20, Number 3 • July 2007		 Arrow Bullet Return to Table of Contents
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Hepatosplenomegaly in a "Lost Boy of Sudan"

Scott C. Adams, MD, and William G. Schucany, MD

A 21-year-old Sudanese man presented to the emergency department after 2 days of fever, nausea, vomiting, and mild bloody diarrhea. Clinical findings included hepatosplenomegaly and abdominal distension. Past medical history included hepatitis B infection and prior infection with a "worm." The patient had moved to the USA 6 weeks prior to his admission. Laboratory findings revealed a decreased white blood cell count of 4100/µL (reference range, 4500-11,000) with peripheral eosinophilia: the white cell differential included 43% eosinophils (reference range, 0%-5%), and the absolute eosinophil count was 2370/µL (reference range, 50-500).

Abdominal imaging studies (ultrasonography, abdominal computed tomography [CT], and abdominal magnetic resonance imaging [MRI]) all demonstrated hepatosplenomegaly. Given the patient's clinical history of hepatitis B, this finding was attributed to chronic hepatitis. In addition, the abdominal sonogram demonstrated nonspecific periportal increased echogenicity. Abdominal CT showed periportal contrast enhancement. Abdominal MRI demonstrated periportal edema on T1- and T2-weighted images with periportal enhancement after the intravenous administration of gadolinium contrast agent (Figures 1 and 2).

What is the most likely diagnosis?