Giant hepatic hemangioma with internal necrosis discovered due to fever of unknown origin and treated successfully with surgical resection: a case report

Hepatic hemangiomas are typically asymptomatic benign liver tumors. This report describes a case of a large hepatic hemangioma with internal bleeding and necrosis, presenting as fever of unknown origin, which was successfully treated with surgical resection. A woman in her 40s presented with persistent fever and fatigue. Imaging revealed a 13 cm mass in the posterior sector of the right hepatic lobe, with areas of high attenuation suggestive of internal bleeding. Laboratory tests revealed elevated levels of C-reactive protein, interleukin-6, and complement components (C3, C4, and CH50), along with an increased erythrocyte sedimentation rate. Symptomatic treatment with antipyretic medications failed to resolve the fever; therefore, hepatic resection was performed for diagnostic and therapeutic purposes. Post-operative recovery was uneventful, and the fever resolved completely. Pathological examination revealed cavernous hemangioma with well-defined necrotic areas. Post-operative blood tests showed normalization of the preoperatively elevated prognostic markers. Bleeding and necrosis associated with a large hemangioma appear to trigger the release of damage-associated molecular patterns, stimulating interleukin 6 production, promoting prostaglandin E2 synthesis, and ultimately leading to fever. Hepatic resection is an effective treatment for large hemangiomas in patients presenting with fever.