On physical examination, the patient was noted to have hepatomegaly and generalized lymphadenopathy. Preliminary laboratory test results showed a total white blood cell count of 11.0×103 cells/mm3, a hemoglobin count of 130 g/L, a hematocrit of 0.37, and a platelet count of 289×109/L. The patient's liver enzyme, amylase, and electrolyte values were within the normal range. An abdominal computed tomographic scan (Figure 1), with contrast, showed high-attenuation nodular fluid–containing lesions of soft tissue density that were diffusely distributed in the liver. The largest lesion measured 2.2 cm in diameter. A computed tomographic scan of the sinuses showed pansinusitis. A chest computed tomographic scan showed irregular soft tissue densities in the posterior lung bases bilaterally representing areas of atelectasis. Multiple serologic examinations were obtained including those for human immunodeficiency virus, hepatitis A, B, and C, cytomegalovirus, Echinococcus sp, Entamoeba histolytica, Toxocara sp, Mycoplasma, Toxoplasma, and alpha1-fetoprotein. A single photon emission computed tomographic technetium Tc 99m sulfur colloid liver-spleen scan was performed to differentiate between focal nodular hyperplasia and hepatic adenomas (Figure 2). The procedure demonstrated multiple "cold" liver defects and splenomegaly. A single photon emission computed tomographic red blood cell liver scan tagged with 99m Tc microlite showed no hemangiomas.