Relapse of Intestinal and Hepatic Amebiasis After Treatment

Excerpt

Six months after returning from a trip to Hawaii, a previously healthy 63-year-old man presented with 5 months of right upper-quadrant abdominal pain and non-bloody diarrhea, 3 months of nausea and non-bloody vomiting, and 1 month of fevers, chills, night sweats, and anorexia, culminating in a loss of 20 lbs. Comprehensive laboratory tests were notable for leukocytosis with a white blood cell (WBC) count of 11,300/mm³ with 88% neutrophils, elevated liver chemistry tests (total bilirubin 0.6 mg/dl, aspartate aminotransferase [AST] 64 U/l, alanine aminotransferase [ALT] 92 U/l, and alkaline phosphatase 674 U/l), and renal failure (blood urea nitrogen 57 mg/dl, creatinine 2.3 mg/dl). Due to his renal insufficiency, non-contrast imaging of the abdomen was obtained, which revealed a 12-cm, thick-walled, multiloculated cystic lesion in the right lobe of the liver (Fig. 1a). Cultures obtained from the patient’s blood, stool, and fluid aspirated from the liver abscess remained sterile. However, serum antibodies to Entamoeba histolytica were positive at a titer of 1:128.

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