16 year old MN DSH hx of mild azotemia, intermittent V&D that improved on dry hydrolyzed diet, diabetes mellitus with insulin change from NPH to glargine in the fall, ALP has been increasing and he has been steadily losing weight. Ultrasound 2 months ago showed 1 liver nodule and a hyperechoic, enlarged liver. Now three liver nodules. An aspirate just showed hepocellular vacuolarization & mild inflam. He has also had thickening of the ileum that has increased between the two ultrasounds (NSF on aspirate). No lymphadenopathy, adrenals normal size. Seeking advice for next steps.
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Did you get a culture of the liver nodule may be low grade granuloma/.abscess and fits with the cyto results. Diabetics get suppurative hepaitis. May need 4 weeks of baytril or similar depending on culture results. The Ileum looks like chornic enteritis that’s currently stable wiht the increased submucosal thickening an dragged contour.
I did not get a culture unfortunately, but that is a great idea. Thank you.