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[Amebic liver abscess of unusual presentation]
Schweizerische Medizinische Wochenschrift
|June 12, 1976
Summary
This case highlights the risks of iodoquinolones in tropical travelers. Early treatment for suspected amebic liver abscess is crucial, even if initial tests are negative.
Area of Science:
- Infectious Diseases
- Hepatology
- Tropical Medicine
Background:
- Amebiasis is a parasitic infection prevalent in tropical regions.
- Previous treatment with metronidazole and iodoquinolones for amebic dysentery was noted.
- Recurrent gastrointestinal symptoms suggested ongoing or reactivated parasitic infection.
Observation:
- A 35-year-old male presented with acute anorexia, vomiting, and high fever after extensive tropical travel.
- Clinical examination was unremarkable, and initial stool examinations for amebae were negative.
- A liver scan indicated a suspicious "expansive process" in the right lobe, prompting further investigation.
Findings:
- Presumptive diagnosis of amebic liver abscess led to prompt metronidazole therapy.
- Rapid defervescence within 24 hours of starting metronidazole strongly suggested an amebic etiology.
- A subsequent liver scan confirmed the abscess, and a positive immunofluorescence test (1/480) confirmed amebiasis.
- Initial serological tests for amebiasis were negative, becoming positive later in the disease course.
Implications:
- This case underscores the potential dangers of inappropriate iodoquinolone use in individuals with a history of tropical travel.
- Amebic liver abscess can present with systemic symptoms like fever, even without localized abdominal signs.
- Early empirical treatment for suspected hepatic amebiasis is recommended.
- Negative initial serological tests do not rule out amebiasis; repeat testing after treatment initiation may be necessary.