Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report
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CASE REPORT
Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report Rainer W. J. Kaiser1,2* , Julian Allgeier3, Alexander B. Philipp3, Julia Mayerle3, Camilla Rothe4, Claudia Wallrauch4 and Mark op den Winkel3
Abstract Background: Infection with Entamoeba histolytica and associated complications are relatively rare in developed countries. The overall low prevalence in the Western world as well as the possibly prolonged latency period between infection with the causing pathogen and onset of clinical symptoms may delay diagnosis of and adequate treatment for amoebiasis. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex. Case presentation: A 30-year-old Caucasian woman in early pregnancy presented to our emergency department with abdominal pain alongside elevated inflammatory markers and liver function tests. Travel history revealed multiple journeys to tropic and subtropic regions during the past decade and a prolonged episode of intermittently bloody diarrhea during a five month stay in Indonesia seven years prior to admission. Sonographic and magnetic resonance imaging revealed a 5 × 4 cm hepatic abscess. After ultrasound-guided transcutaneous liver drainage, both abscess fluids and blood cultures showed neither bacterial growth nor microscopic signs of parasitic disease. Serological testing confirmed an infection with Entamoeba histolytica, which was treated with metronidazole, followed by eradication therapy with paromomycin. Subsequent clinical, laboratory and imaging follow-up exams showed regression of the ALA. In addition, the pregnancy completed without complications and a healthy baby boy was born 7 months after termination of treatment. Conclusions: This case of invasive amoebiasis in early pregnancy outside of endemic regions and several years after exposure demonstrates the importance of broad differential diagnostics in the context of liver abscesses. The complex interdisciplinary decisions regarding the choice of imaging techniques as well as interventional and antibiotic therapy in the context of pregnancy are discussed. Furthermore, we present possible explanations for pregnancy as a risk factor for an invasive course of amoebiasis. Keywords: Entamoeba histolytica, Amoebic liver abscess, Pregnancy, Paromomycin, Embryotoxicity, Case report
*Correspondence: [email protected]‑muenchen.de 1 Department of Medicine I, LMU Klinikum, Ludwig-MaximiliansUniversity, Munich, Germany Full list of author information is available at the end of the article
Background Amoebiasis, which is caused by infection with the anaerobic protozoan Entamoeba histolytica and other Entamoeba species [1], is recognized as the fourthleading cause of death by parasite infection worldwide [2]. Annually, around 50 million patients develop symptoms of amoebic dysentery or e
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