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case_images: CT scan showing thickened rectal wall.
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case_images: An abdominal and pelvic CT scan showed extensive non-enhancing hypodense nodules within both lobes of the liver, ranged in size from 1 to 3 cm, and thickened rectal wall (Fig. 1).
case_images: CT scan showing subcapsular deposits-frosted liver (black arrow) and parenchymal deposits (red arrow) (A). Para-aortic lymphadenopathy (blue arrow) (B). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
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case_images: Another triphasic CT scan revealed subcapsular deposits, parenchymal deposits and para-aortic lymphadenopathy (Fig. 2).
case_images: Colonoscopy images showing normal rectum.
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case_images: The entire course of the large intestine, up to the cecum, was thoroughly investigated during the colonoscopy, however, no obvious signs of strictures, polyps, aberrant growths, or ulcerations were seen (Fig. 3).
case_images: Endoscopy (normal).
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case_images: However, the procedure did not reveal any pathology (Fig. 4).
case_images: The examined sections of the liver tissue display distorted architecture, showing numerous granulomas. These granulomas consist of epithelioid cells, which are surrounded by infiltrating lymphocytes and Langhan's multinucleated giant cells. Moreover, areas of tissue necrosis and fibrosis are seen.
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case_images: An ultrasound-guided liver biopsy from the right hepatic area was taken whose results were surprising since they showed a pattern of necrotizing granulomatous inflammation with caseous necrosis (Fig. 5A). During laparoscopy, two tiny biopsies were taken from the liver nodules whose confirmed the results of the initial biopsy, which had previously demonstrated the existence of a necrotizing granulomatous inflammation with an accompanying caseous necrosis (Fig. 5B).