Giant Amoebic Liver Abscess: A Rare Diagnosis in a Rural Setting of Sub-Saharan Africa

Abstract

Background. Extraintestinal amoebiasis is an uncommon complication of Entamoeba histolytica infection, occurring in about 5-10% of patient. Prompt diagnosis and management is essential to prevent complications. However, diagnosis and management in resource-limited settings is very challenging owing to limited diagnostic tools and nonspecific clinical symptoms. Therefore, our case report underscores the role of incisive clinical evaluation, basic investigation, and nonsurgical management of giant amoebic abscess in resource-limited settings. Case Presentation. A 13-year-old female Cameroonian presented with subacute onset of upper abdominal pain, high fever, and chest pain for one week. Before presentation, she had been on treatment at a local traditional practitioner during which her symptoms worsen. After clinical evaluation and basic investigation, she was diagnosed with a giant amoebic liver abscess. She was resuscitated and placed on nonsurgical management. Follow-up after 1 month was significant for complete recovery. Conclusion. Amoebic liver abscess is a rare complication of Entamoeba histolytica infection with devastating complications. The diagnosis of this disease requires high index of suspicion in resource-limited settings. Good clinical evaluation and timely nonsurgical therapy can provide recovery to some patients.

Percutaneous Drainage as The Management of Amebic Liver Abscess (ALA): A Case Report

“…A high incidence of E. histolytica infection was found in the lowmiddle income countries [8]. E. histolytica infection is reported as the third-highest cause of parasitic infection death-related after malaria and schistosomiasis [9]. It is estimated that there were 50 million cases of amebiasis with a mortality rate of 100,000 deaths per year worldwide [7].…”

“…These motile trophozoites will migrate to the colon and cause damage to the columnar epithelium of the Lieberkühn crypts causing inflammation and ulceration. The trophozoites will then penetrate the peritoneal cavity or spread to the liver, lungs, and other extraintestinal organs through the portal venous circulation [9]. The inflammation caused by these trophozoites in the liver will lead to necrosis of hepatocytes and the formation of brownish exudates with characteristics similar to "anchovy paste" [3].…”

“…Hepatomegaly may be found in 30-50% of ALA cases. 9 Diarrhea is found in less than one-third of patients and dysentery can be found several months before the onset of ALA [6]. About 80% of ALA patients had a fever and right upper quadrant abdominal pain within 2-4 weeks after the abscess formation [10].…”

“…The pulmonary infection may be caused directly by the extension of liver abscess or indirectly from the hematogenous or lymphatic spread. The clinical manifestations of pulmonary amebiasis were includes fever, hemoptysis, and referred pain on the right shoulder or right scapula region [9]. Other complaints, such as cough and dull percussion sound or crackles sound in the lower lobe of the right lung, could be found in the pleuropulmonary amebiasis [10].…”

“…Serological tests, such as indirect hemagglutination assay (IHA), latex agglutination, indirect immunofluorescence assay (IFA), or enzyme-linked immunosorbent assay (ELISA), play important role in the diagnosis of ALA [9] Serological examination (IgG) has a high sensitivity. However, in endemic areas with repeated exposure to E. histolytica, a definitive diagnosis of ALA based on the high IgG titer is challenging because it cannot distinguish acute amebiasis from long-standing amoeba infections [1,8,9]. Detection of Gal/GalNac E. histolytica antigen in the serum had a sensitivity of >95% and a specificity of 100% for diagnosing ALA.…”