Ruptured Amoebic Liver Abscess With Empyema, Venous Thromboembolism and Bronchopleural Fistula: A Case Report

Amoebiasis, a gastrointestinal infection caused by Entamoeba histolytica, is the third leading cause of mortality worldwide among parasitic infections with over 100,000 deaths annually. Apart from dysentery, it can manifest as extraintestinal disease, most commonly liver abscess, and rarely pulmonary, cardiac, and brain involvement. This case demonstrates the challenging management of a complicated amoebic liver abscess (ALA) with pulmonary involvement and venous thromboembolism. A 26-year-old male presenting with pleuritic right hypochondriac pain, fever, and dyspnoea underwent hepatobiliary ultrasonography (US) which showed a liver abscess. Computed tomography (CT) of the thorax and abdomen revealed a ruptured right liver abscess with infra-diaphragmatic intrathoracic extension and right lung empyema with the presence of inferior vena cava (IVC) and right hepatic vein thrombosis, and right pulmonary embolism. He underwent placement of a percutaneous pigtail thoracostomy catheter for drainage of right lung empyema which was complicated with a bronchopleural fistula. Amoebiasis serology was later reported positive for immunoglobulin G (IgG). The patient was treated with medical therapy which included tissue and luminal amebicides and warfarin. Video-assisted thoracoscopy surgery (VATS) was performed to visualize and repair the bronchopleural fistula. Follow-up CT revealed significant reduction in size of the right lateral intrathoracic and liver abscess. This case underscores the importance of awareness of pulmonary involvement in ALA and the associated risk of venous thromboembolism as early detection facilitates effective management and reduces mortality.