A rare hepatic mass in an Italian resident

Abstract

Background Amebiasis is a rare condition in developed countries but epidemiologically growing. Clinical manifestation may range from asymptomatic to invasive disease, amoebic liver abscess being the most common manifestation. We report a peculiar case of left hepatic amoebic liver abscess in a patient without a well-known source of infection and presenting with left portal vein thrombosis. Case presentation Patient, working as longshoreman, presented with complaints of remittent-intermittent fever lasting from 2 weeks. Physical examination was normal. Blood tests showed mild anemia, neutrophilic leukocytosis and elevated inflammation markers. Chest x-rays was normal. Abdominal ultrasound showed multiple hypoechoic liver masses. CT-scan of abdomen showed enlarged left liver lobe due to the presence of large abscess cavity along with thrombosis of left portal vein. The indirect hemagglutination test for the detection of antibodies to Entamoeba histolytica (Eh) was positive. Ultrasound-guided percutaneous drainage revealed “anchovy sauce” pus. Metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity. Conclusion This case shows that amoebic liver abscess is possible even in first world country patients without travel history. Left sided abscess and portal vein thrombosis are rare and hence reported.

Asymptomatic Incidental Pyogenic Hepatic Abscess in an Obese Adult

“…As described in previous literature, the risk of PHA development is increased with underlying risk factors such as IV drug abuse, DM, malignancy, other comorbidities [ 1 ]. Furthermore, there are often typical clinical signs and symptoms associated with PHA that can help guide clinicians toward accurate diagnosis and treatment including but not limited to fevers, chills, RUQ pain, high ALT, and high alkaline phosphatase concentrations [ 6 , 8 ]. However, our patient’s only co-morbidity was obesity, which can alter immune function [ 9 ].…”

Amebic liver abscess by Entamoeba histolytica

“…When events such as these are detected using CT, they may indicate a more severe disease that demands more aggressive management, including percutaneous drainage[ 61 ]. However, there has been one report of a left hepatic ALA in a patient who had no clear source of infection, initially presenting with a left portal vein thrombosis[ 22 ].…”

“…The geographic distribution of amebiasis has worldwide amplitude and a high rate of incidence, and it remains a public health concern in low- and middle-income developing countries in the tropics, particularly in environments that are crowded and lacking in adequate sanitation and clean water due to the oral-fecal route of pathogen transmission (including ingestion of food or water that contains cysts from this protozoan)[ 6 , 16 - 19 ]. On the other hand, this pathogen is only rarely seen in wealthier countries but is epidemiologically growing; in particular, recent immigrants from endemic regions (or travelers returning from a long-term stay in an endemic region) have a greater risk of developing amebiasis[ 6 , 20 - 22 ].…”

Neutrophils vs. amoebas: Immunity against the protozoan parasiteEntamoeba histolytica

“…In several developing countries such as Mexico, 3,4 intestinal protozoan infections are a primary cause of death among young children, 5,6 and in those individuals who survive, long‐term adverse effects are commonly observed 3,7–9 . Due to modern travel options, amoebic infections are also frequently reported in developed countries 10–12 . E. histolytica colonizes the intestinal tract triggering diarrhea, dysentery, and colitis.…”