Intrathoracic rupture of amebic liver abscess: a case report and literature review

Amebic liver abscess (ALA) is a serious complication of Entamoeba histolytica infection. In rare cases, ALA may rupture into the thoracic cavity, leading to a high risk of death. Differentiating intrathoracic ALA rupture from reactive pleural effusion is essential for predicting the clinical course and appropriate management.

A 46-year-old bisexual man with well-controlled human immunodeficiency virus infection presented with pain in the right shoulder and upper abdomen. Imaging revealed a solitary liver abscess with diaphragmatic rupture, right pleural effusion, and portal vein thrombosis. Results of stool microscopy, antigen testing, and cytology of pleural and liver aspirates were inconclusive. However, E. histolytica was identified in the stool, liver abscess aspirate, and pleural fluid using polymerase chain reaction tests. Despite the initial therapy with metronidazole, the thoracic fluid volume increased considerably, necessitating thoracic and hepatic drainage. After stabilization, anticoagulation therapy with edoxaban for portal vein thrombosis and luminal therapy with paromomycin were initiated. The patient showed progressive clinical improvement, and follow-up imaging confirmed shrinkage of the liver abscess and resolution of the thrombus and diaphragmatic rupture. No recurrence was observed during the 6-month follow-up period.

We reported the case of a patient with a rapidly progressive ALA with intrathoracic rupture. In cases of ALA with thoracic rupture, performing drainage is important, considering that pleural effusion may progress rapidly. This case highlights the need for comprehensive management involving timely antimicrobial and anticoagulation therapy in cases of vascular thrombosis.