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Cholangiocarcinoma masquerading as liver abscess.
1Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Summary
This case study highlights how liver fluke (O. viverrini) infection can mimic a liver abscess, leading to a cholangiocarcinoma diagnosis. Early symptoms of abdominal pain and fever may mislead clinicians.
Area of Science:
- Hepatology
- Infectious Diseases
- Gastroenterology
Background:
- Liver abscesses present with abdominal pain and fever, often requiring drainage and antibiotics.
- Liver fluke (Opisthorchis viverrini) infection is endemic in Southeast Asia and linked to cholangiocarcinoma.
- Differentiating liver abscess from other liver pathologies is crucial for effective treatment.
Observation:
- A 60-year-old man presented with symptoms suggestive of a liver abscess, including right upper quadrant pain and fever.
- Initial aspiration yielded pus, but cultures were negative for bacteria, and serology for Entamoeba histolytica was negative.
- Despite initial response to metronidazole, symptoms recurred, and further investigation revealed Opisthorchis viverrini ova in stool.
Findings:
- The patient was diagnosed with cholangiocarcinoma (CCC) associated with Opisthorchis viverrini infection.
- The clinical presentation and initial findings of anchovy sauce-like pus mimicked a pyogenic liver abscess.
- Enterobacter agglomerans was isolated in the second aspiration, complicating the initial diagnosis.
Implications:
- Opisthorchis viverrini infection, a risk factor for cholangiocarcinoma, can present atypically, mimicking liver abscesses.
- This case underscores the importance of considering parasitic infections and associated malignancies in liver disease diagnosis.
- Accurate diagnosis is critical, as treatment and prognosis differ significantly between liver abscess and cholangiocarcinoma.