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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  
  1. CT computed tomography, PCR polymerase chain reaction, ND not determined
  2. aResults from samples collected June 9, 2013 and September 4, 2013, respectively (cut off <1:40)
  3. bOne week after presentation during the 3rd episode the patient was readmitted and C-reactive protein decreased to 46 mg/L, aspartate aminotransferase increased to and 42 U/L and gamma-glutamyltransferase increased to 129 U/L, the size of the abscess increased to 5 × 7 cm
  4. cState of the art treatment on all occasions: nitroimidazole derivate followed by a luminal agent