Published online Jan 6, 2023. doi: 10.12998/wjcc.v11.i1.177
Peer-review started: September 13, 2022
First decision: October 14, 2022
Revised: October 21, 2022
Accepted: December 19, 2022
Article in press: December 19, 2022
Published online: January 6, 2023
A 70-year-old man with hepatitis C virus-related recurrent hepatocellular carcinoma was admitted for further diagnosis of a 1 cm iso-hyperechoic nodule in segment (S) 5.
Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) revealed the nodule in S5 with a defect at the hepatobiliary phase, hyperintensity on diffusion weighted imaging (DWI) and hypointensity on apparent diffusion coefficient (ADC) map. Contrast-enhanced computed tomography revealed hypervascularity at the early phase, and delayed contrast-enhancement was observed at the late phase. Contrast-enhanced ultrasound (US) revealed incomplete defect at the late vascular phase. Inflammatory liver tumor, lymphoproliferative disease, intrahepatic cholangiocarcinoma (small duct type) and bile duct adenoma were suspected through the imaging studies. US guided biopsy, however, showed a noncaseating hepatic sarcoid-like epithelioid granuloma (HSEG), and histopathological analysis disclosed spindle shaped epithelioid cells harboring Langhans-type multinucleated giant cells. One month after admission, EOB-MRI signaled the disappearance of the defect at the hepatobiliary phase, of hyperintensity on DWI, of hypointensity on ADC map, and no stain at the early phase.
That the patient had received BNT162b2 messenger RNA (mRNA) coronavirus disease 2019 vaccination 3 mo before the occurrence of HSEG, and that its disappearance was confirmed 4 mo after mRNA vaccination suggested that the drug-induced sarcoidosis-like reaction (DISR) might be induced by the mRNA vaccination. Fortunately, rechallenge of drug-induced DISR with the third mRNA vaccination was not confirmed.
Core Tip: We describe a case of drug-induced sarcoidosis-like reaction (DISR) a noncaseating hepatic sarcoid-like epithelioid granuloma (HSEG). Histopathological analysis disclosed, characteristic spindle-shaped epithelioid cells harboring Langhans-type multinucleated giant cells. Two months and 5 mo after the third BNT162b2 messenger RNA (mRNA) coronavirus disease 2019 vaccination, the occurrence of HSEG was not confirmed before rechallenging the drug-induced DISR by the third mRNA vaccination.