A Lilliputian army under the floorboards: persistent delirium with complete though prolonged recovery

Area of Science:

• Geriatrics
• Infectious Diseases
• Hepatology

Background:

• Amoebic liver abscess (ALA) is a serious infection, often presenting with non-specific symptoms.
• Delayed presentations of ALA, particularly decades after initial exposure, are rare but possible.
• Delirium in older adults can be multifactorial, requiring a broad differential diagnosis.

Observation:

• An 83-year-old male presented with insidious-onset fluctuating delirium.
• The patient experienced a fall, severe weight loss, and acute kidney injury (AKI).
• The underlying cause was identified as an amoebic liver abscess, diagnosed over 30 years post-exposure.

Findings:

• Despite significant comorbidities and a poor initial prognosis, the patient achieved complete recovery.
• The clinical course spanned two years, emphasizing the prolonged nature of recovery.
• The case underscores the potential for full recovery with timely and comprehensive medical care.

Implications:

• Falls in older adults can be a critical trigger for uncovering underlying, long-undiagnosed conditions.
• A high index of suspicion and differential diagnostic approach are crucial for insidious delirium, avoiding misdiagnosis as dementia.
• This case emphasizes the importance of considering rare infectious etiologies even after long latency periods.