66-year-old woman with type II diabetes treated with biphasic insulin at doses of 16 IU - 0 - 18 IU, complaining of abdominal pain of one month duration without other accompanying symptoms, except for the need to progressively increase insulin dose 54 IU.
Her physical examination was normal and analytically highlighted a platelet count (601,000/l) and ESR (107 mm/1 hour), with normal levels of CMV, IgG antibodies, thyroid cancer, and serum immunoglobulin levels.
The study with abdominal ultrasound demonstrated the presence of two space occupying lesions located in the right liver lobe, with a size of 4.3 x 3.2 cm and 3.5 x 2.4 cm respectively, and another lobe with a nonspecific contrast CAT scan also showed a lesion of 3.5 cm in the left lobe and a lesion in the same liver.
Percutaneous liver biopsy under ultrasound guidance was performed to rule out malignancy. Histopathological analysis revealed an extensive infiltrate consisting of plasma cells and, to a lesser extent, lymphocytes and inflammatory multinucleated giant cells, compatible with pseudotum.
Immunohistochemical analysis showed plasma cells with kappa- and lambda- chains in equal proportion, with predominance of IgG chains but absence of IgG4 positive plasma cells.
Since the patient was asymptomatic and with better glycemic control, no special measures were taken and it was decided to reassess the patient one month later by means of a new ultrasound study, which showed spontaneous resolution of liver lesions.
The patient remained asymptomatic during this time period, with a progressive decrease in insulin requirements until stabilized at the usual basal dose.
