Abstract
A 77-year-old man was referred to our hospital for fever and appetite loss that appeared at the end of September 2005. He showed an inflammatory reaction and enzyme elevation of hepatobiliary origin, and was hospitalized. Since a biliary tract infectious disease was considered, a general antibiotic dosage was started. However, the leukocyte elevation and fever continued. After several days of hospitalization, MRI revealed that a group of small cystic lesions were scattered in both lobes of the liver: some of them showed a contrasting effect in their circumferences. The inflammatory reaction improved when the medication was changed to a combination of wider-spectrum antibiotics and antifungus, although a diagnosis of multiple liver abscess was still possible from the imaging. The contrasting effect recognized in the cyst circumference disappeared promptly, but the small cystic lesions were still present multiply in both lobes of the liver when MRI was done at 1 month of hospitalization and at 6 months later. It was thought, thus, to be an infection of pre-existing cysts. Biliary hamartoma is usually symptom-free, but in this case, together with the cystic infection, the differentiation from multiple hepatic abscess was difficult. In this case, the diagnosis was possible based on the clinical course and imaging.
