Infectious causes of this patient's presentation include pyogenic, amebic or, less likely, fungal hepatic abscess. Pyogenic or amebic abscesses typically present with right upper quadrant pain. Fever may or may not be present and laboratory values are often relatively unperturbed. Amebic serology is a good, non-invasive way to distinguish the etiology of a liver abscess, particularly as amebic disease typically responds to medical therapy alone, but pyogenic abscesses often require drainage. The CT appearance of the lesion in our patient was relatively homogeneous and did not enhance with contrast which would be atypical for abscess.
Cats are the most important reservoir.
In contrast to the current case, patients presenting with peliosis hepatitis typically have multiple hepatic lesions, fever and advanced immunosupression. Among non-infectious etiologies, primary hepatic malignancy or metastasis from the GI tract need be considered. Click here for a larger view. A lumbar puncture contained a small population of unusual B-cells. The patient was subsequently initiated on chemotherapy including cyclophosphamide, doxarubicin and etoposide.