Table 1.
Clinical characteristics of the 3 episodes of amebic liver abscesses
| 1st episode (1997) | 2nd episode (2001) | 3rd episode (2013) | |
|---|---|---|---|
| Age (years) | 23 | 27 | 39 |
| Symptoms | 4 weeks fever, sweating, upper right abdominal pain | 5 days spiking fever, malaise | 5 days spiking fever, sweating, upper abdominal pain |
| Physical examination | Temperature 38.4, upper right abdominal tenderness | No abnormalities | temperature 37.1, upper abdominal tenderness |
| Laboratory tests (reference range) | |||
| Hemoglobin mmol/L (8.5–11.0) | 7,2 | 8,3 | 8,7 |
| Leucocytes × 109/L (4.0–10.0) | 11 | 19,7 | 24,4 |
| C-reactive protein mg/L (0–5) | ND | 276 | 339b |
| Erythrocyte sedimentation rate mm/hr (<15) | 94 | 63 | 74 |
| Bilirubin total µmol/L (0–17) | 8 | 29 | 15 |
| Aspartate aminotransferase U/L (0–35) | 23 | 19 | 28b |
| Alanine aminotransferase U/L (0–45) | 69 | 46 | 23 |
| Alkaline phosphatase U/L (0–390) | ND | 107 | 99 |
| Lactate dehydrogenase U/L (0–248) | 244 | 288 | 160 |
| Gamma-glutamyltransferase U/L (0–55) | 190 | 58 | 63b |
| Creatinine µmol/L (64–104) | ND | 101 | 86 |
| Radiology | Liver abscess in the right lobe, size 6 × 5 cm (ultrasound) | Abscess high in the liver, size 10 cm (CT) | Liver abscess in the right lobe, size 4.9 × 4.5 cm with satellite abscesses (CT)b |
| Additional tests | |||
| Stool microscopy | Entamoeba spp. Cysts | Negative | Entamoeba spp. cysts and trophozoites |
| Stool PCR E. histolytica | ND | ND | positive |
| Serology for amebiasis | <1:40, 1 month later 1:320 | 1:320 | 1:640 and 1:640a |
| Abscess fluid | ND | Culture negative, no amebic trophozoites | ND |
| Treatment | Metronidazole 750 mg tid 7 days | Metronidazole 750 mg tid 10 days | Metronidazole 750 mg tid 10 days |
| Diloxanide furoate 500 mg tid 10 days | Diloxanide furoate 500 mg tid 10 days | Paromomycin 500 mg tid 10 days | |
| Aspiration and drainage liver abscess | |||
CT computed tomography, PCR polymerase chain reaction, ND not determined
aResults from samples collected June 9, 2013 and September 4, 2013, respectively (cut off <1:40)
bOne week after presentation during the 3rd episode the patient was readmitted and C-reactive protein decreased to 46 mg/L, aspartate aminotransferase increased to and 42 U/L and gamma-glutamyltransferase increased to 129 U/L, the size of the abscess increased to 5 × 7 cm
cState of the art treatment on all occasions: nitroimidazole derivate followed by a luminal agent