1 - Pediatric Area, Hospital Dona Estefânia, CHULC
2 - Infectiology Unit, Hospital Dona Estefânia, CHULC
3 - Gastroenterology Unit, Hospital Dona Estefânia, CHULC
- 41st Annual Meeting of the European Society for Paediatric Infectious Diseases, Oral Presentation
Background: Amebiasis is a parasitic disease caused by Entamoeba histolytica, which mainly affects people from developing countries. The majority of individuals have intestinal tract infections. Occasionally, they can present with extraintestinal infection, most commonly liver abscess.
Case presentation: We describe a 6-years-old girl, born and resident in São Tomé and Principe evacuated to Portugal due to a hepatic abscess. She presented recurrent episodes of abdominal pain and fever for 4 years. No other significant medical or surgical history was present. On physical examination she presented deep abdominal left flank tenderness, without hepatomegaly. Abdominal computed tomography (CT) revealed a heterogeneous liver hypoechoic mass, 40 x 33 x 24 mm, with peripheral calcifications and two central necrotic regions, in segment 7 of the liver, suggestive of abscesses. Blood tests showed white cell count 9.8 × 10^9/L, C-reactive protein 9 mg/L, alkaline phosphatase 277 U/L, AST 25 U/L, ALT 14 U/L Bilirrubin?. tumor markers, Blood cultures, IGRA, HIV, Bartonella, Brucella and echinococcus serology and stool parasitological examination were negative. Serology for Entamoeba histolytica (IgG) was positive and stool PCR was negative. Management included oral metronidazole. Abdominal ultrasound scan taken 1 year later showed calcification of the abscess and decreased size.
Conclusion: Amoebic liver abscess can cause significant morbidity and mortality. Although there is a broad differential diagnosis, epidemiologic history and serology are important clues to the diagnosis. In this case, there was no need of surgical approach because of a good medical therapy response. PCR in stool was negative, so we decide not to start luminal therapy also.
Keywords: Liver abscess, amebiasis, amebic liver abscess