Table 1 Clinical characteristics of the 3 episodes of amebic liver abscesses
From: Recurrent amebic liver abscesses over a 16-year period: a case report
1st episode (1997) | 2nd episode (2001) | 3rd episode (2013) | |
|---|---|---|---|
Age (years) | 23 | 27 | 39 |
Symptoms | 4 weeks fever, sweating, upper right abdominal pain | 5 days spiking fever, malaise | 5 days spiking fever, sweating, upper abdominal pain |
Physical examination | Temperature 38.4, upper right abdominal tenderness | No abnormalities | temperature 37.1, upper abdominal tenderness |
Laboratory tests (reference range) | |||
Hemoglobin mmol/L (8.5–11.0) | 7,2 | 8,3 | 8,7 |
Leucocytes × 109/L (4.0–10.0) | 11 | 19,7 | 24,4 |
C-reactive protein mg/L (0–5) | ND | 276 | 339b |
Erythrocyte sedimentation rate mm/hr (<15) | 94 | 63 | 74 |
Bilirubin total µmol/L (0–17) | 8 | 29 | 15 |
Aspartate aminotransferase U/L (0–35) | 23 | 19 | 28b |
Alanine aminotransferase U/L (0–45) | 69 | 46 | 23 |
Alkaline phosphatase U/L (0–390) | ND | 107 | 99 |
Lactate dehydrogenase U/L (0–248) | 244 | 288 | 160 |
Gamma-glutamyltransferase U/L (0–55) | 190 | 58 | 63b |
Creatinine µmol/L (64–104) | ND | 101 | 86 |
Radiology | Liver abscess in the right lobe, size 6 × 5 cm (ultrasound) | Abscess high in the liver, size 10 cm (CT) | Liver abscess in the right lobe, size 4.9 × 4.5 cm with satellite abscesses (CT)b |
Additional tests | |||
Stool microscopy | Entamoeba spp. Cysts | Negative | Entamoeba spp. cysts and trophozoites |
Stool PCR E. histolytica | ND | ND | positive |
Serology for amebiasis | <1:40, 1 month later 1:320 | 1:320 | 1:640 and 1:640a |
Abscess fluid | ND | Culture negative, no amebic trophozoites | ND |
Treatment | Metronidazole 750 mg tid 7 days | Metronidazole 750 mg tid 10 days | Metronidazole 750 mg tid 10 days |
Diloxanide furoate 500 mg tid 10 days | Diloxanide furoate 500 mg tid 10 days | Paromomycin 500 mg tid 10 days | |
Aspiration and drainage liver abscess | |||