A Case of an 80-Year-Old Woman With Chronic Eosinophilic Pneumonia and Clinically Significant Giant Hepatic Hemangioma.

An 80-year-old woman with a history of chronic eosinophilic pneumonia (CEP), severe persistent asthma, concomitant severe idiopathic urticaria, fibrous dysplasia of bone, osteoporosis resulting from years of oral corticosteroid usage, and arthralgia, presented to the allergy and immunology clinic with abdominal discomfort. Abdominal and pelvic CT scan showed a hepatic hemangioma, measuring approximately 8.2 x 6.4 cm. The patient underwent arterial embolization with no improvement in size or symptoms. CT scan of the same area taken eight years later had the same large, well-defined hypodense lesion in the right hepatic lobe that increased in size to 10.5 x 7.3 cm. The larger hemangioma now resulted in a mass effect on the upper pole of the right kidney, encroaching on the second portion of the duodenum, and pushing the vertebral column to the left. The patient's CEP was well controlled after desensitization to reslizumab, which initially induced urticaria. Her asthma symptoms are well controlled with reslizumab.  Our patient demonstrates that, even in older age groups, it is still possible to present with mega hepatic hemangiomas, despite the median age of presentation being 46. Patients who experience abdominal symptoms, increased hemangioma size, and anxiety frequently undergo surgical resection. Our patient also met the criteria for a resection. The patient was referred to the University of Pittsburgh for excision. However, despite her CEP and asthma under control, following the principle of primum non nocere (first, do no harm), no treatment was advised, opting for close observation. While larger hemangiomas have been reported, this case demonstrates that even in the elderly, with multiple co-morbidities, one may tolerate a growing mega hepatic hemangioma. Age and comorbidity may preclude operative therapy.