Liver Abscess: A Wolf in Sheep’s Clothing

Excerpt

A 50-year-old Hispanic female was initially evaluated for worsening abdominal pain over 3 months. Her history included factor V Leiden mutation with thrombophilia, associated deep venous thrombosis with pulmonary embolism (DVT/PE), May-Thurner syndrome following left iliac vein stenting which was treated with warfarin, and hypertension. Initial investigation at an outside hospital, where she was evaluated for right upper quadrant (RUQ) pain revealed a white blood cell count of 15 × 10⁹/UL (4.5–11.0 × 10⁹/UL), and serum concentrations of aspartate transaminase (AST) 563 units/L (10–40 unit/L), alanine transaminase (ALT) 413 units/L (7–56 units/L), alkaline phosphatase 290 units/L (38–150 units/L), total bilirubin 2.8 mg/dL (0.3–1.2 units/L) and INR 5.1 (0.8–1.3). …