case_images: PMC8235979_01
case_images: The laboratory data over the clinical course: eosinophils (eosino) and C-reactive protein (CRP). Methylprednisolone (mPSL, 1 g/day) was administered for 3 days. Prednisolone (PSL, 50 mg/day) was started on day 14 and tapered every week or fortnightly. Mepolizumab was administered on day 18.
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case_images: Laboratory testing of blood counts revealed marked eosinophilia (white blood cells (WBC): 14,300/microL and eosinophils: 8,000/microL), polyclonal hyperimmunoglobulinemia (IgG: 2,209 mg/dL, IgG4: 1,220 mg/dL, and IgE: 2,482 IU/dL), and an inflammatory response (C-reactive protein (CRP): 7.40 mg/dL) (Table 1 and Figure 1).
case_images: The histopathological examination of the gallbladder. It reveals a necrotic vasculitis and granulomatous inflammation with marked eosinophilic infiltration.
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case_images: The histopathological findings revealed necrotic vasculitis and granulomatous inflammation with marked eosinophilic infiltration (Figure 2).
case_images: The histopathological findings of the renal biopsy. Marked eosinophil infiltration is found in the interstitium, especially in the subcortex of the kidney, concomitant with tubular atropy. Nephrons are intact.
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case_images: fig3
case_images: On day 11, a kidney biopsy was performed, and the kidney tissue examination showed marked eosinophilic infiltration in the tubulointerstitial area and eosinophilic tubulitis, but glomerulonephritis was absent (Figure 3).