Snowflakes in the Liver

Case Report

Austin J Emergency & Crit Care Med. 2015; 2(7): 1039.

Snowflakes in the Liver

Ceruti S¹* and De Vivo S²

¹Department of Intensive Care Unit, Geneva University Hospitals, Switzerland

²Department of Anesthesiology and Intensive Care, University Hospital “Federico II”, Italy

*Corresponding author: Samuele Ceruti, Department of Intensive Care Unit, Geneva University Hospitals, Geneva, Switzerland

Received: November 10, 2015; Accepted: December 20, 2015; Published: December 24, 2015

Case Presentation

A 43-year-old male patient was admitted to the Emergency Department ward for general malaise with abdominal pain in the right upper quadrant, breath employee, already present two months before and actually increase. There was no sign of fever, pathologic lymphadenopathy, jaundice or other symptoms. At physical examination the patient appeared lucid, well spatial/temporaloriented, afebrile, hemodynamically stable (AP 100/70 mmHg, HR 68 bpm), weight 73 Kg, height 180 cm; all examinations were in the normal range, except for mild deep pain in right upper quadrant and the right shoulder.

Past history

He was born in Portugal, lived in Switzerland from 1983 to 2000, then in France from 2000 to 2007 and again in Switzerland. In 1983 the patient had suffered from Brucellosis, treated with antibiotic therapy for 9 months; an abdominal CT-scan in 1992 revealed multiple hepatic calcifications. In 2001 he had a single episode of nephrolithiasis treated pharmacologically.

Laboratories and radiological findings

The laboratory exams performed show an elevation of GGT (68 U/l), CRP (31,9 mg/l) and ferritin (771 ng/ml), while other routine exams were in the normal range. An abdominal CT-scan showed calcification with a “snowflake appearance” in the liver (Figures 1,2); for our radiologic team these are suggestive for signs of chronic hepatic Brucellosis. The patient was seen twice at our department to undergo liver fine-needle biopsy of the major hepatic lesion, negative for helminths (Trichinellaspp, Toxocariasis, Echinococcusgranulosus, Fasciolaspp, Anguillosisspp, Cisticercosisspp), Protozoa, Parasites and Bacteria.

Citation: Ceruti S and De Vivo S. Snowflakes in the Liver. Austin J Emergency & Crit Care Med. 2015; 2(7): 1039. ISSN : 2380-0879