A rare hepatic mass in an Italian resident
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CASE REPORT
Open Access
A rare hepatic mass in an Italian resident Matteo Borro1,2* , Giuseppe Murdaca1, Monica Greco1, Simone Negrini1 and Maurizio Setti1
Abstract Background: Amebiasis is a rare condition in developed countries but epidemiologically growing. Clinical manifestation may range from asymptomatic to invasive disease, amoebic liver abscess being the most common manifestation. We report a peculiar case of left hepatic amoebic liver abscess in a patient without a well-known source of infection and presenting with left portal vein thrombosis. Case presentation: Patient, working as longshoreman, presented with complaints of remittent-intermittent fever lasting from 2 weeks. Physical examination was normal. Blood tests showed mild anemia, neutrophilic leukocytosis and elevated inflammation markers. Chest x-rays was normal. Abdominal ultrasound showed multiple hypoechoic liver masses. CT-scan of abdomen showed enlarged left liver lobe due to the presence of large abscess cavity along with thrombosis of left portal vein. The indirect hemagglutination test for the detection of antibodies to Entamoeba histolytica (Eh) was positive. Ultrasound-guided percutaneous drainage revealed “anchovy sauce” pus. Metronidazole and a follow up imaging at 3 months showed resolution of abscess cavity. Conclusion: This case shows that amoebic liver abscess is possible even in first world country patients without travel history. Left sided abscess and portal vein thrombosis are rare and hence reported. Keywords: Amebic liver abscess, Sepsis, Amebiasis, High-risk behavior, Multiple pseudo-nodules, Portal vein thrombosis
Background Entamoeba histolytica (Eh) is a protozoan parasite with a simple lifecycle that can exists either in the cyst form that is ingested or in the amoeboid trophozoite stage that is responsible for the disease. Infection is usually taken with ingestion of the cysts in food or water previously contaminated by human faeces [1, 2]. Eh is distributed throughout the world and it represents a health risk in those places where barriers between human faeces and water or food are not adequate [1]. Amoebiasis is the third most common cause of death from parasitic diseases, after schistosomiasis and malaria [3]. Eh infection is endemic in several developing countries like * Correspondence: [email protected] 1 Department of Internal Medicine (DiMI), Clinical Immunology Unit, University of Genoa and Policlinico San Martino, Viale Benedetto XV, 6 -, 16132 Genova, Italy 2 Department of Internal Medicine, San Paolo Hospital, Via Genova 30 -, 17100 Savona, Italy
India, Africa, Mexico, Central America, South America and Indonesia. Clinical manifestations may range from asymptomatic disease, that is the most common presentation, to invasive intestinal and extra-intestinal diseases. Extra-intestinal manifestations are less frequent and characterized by a negative stool antigen detection. Amoebic liver abscess (ALA) is the most common extraintestinal site of infection [4], but it occurs in less than 1% of Eh infections
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