Z Gastroenterol 2004; 42 - 120
DOI: 10.1055/s-2004-827021

Diagnostic labyrinth caused by amoebic liver abscesses

K Rábai 1, T Szamosi 1, É Bács 2, K Nagy 3, Fc Ender 3, E Ludwig 4, J Banai 1
  • 1Department of Internal Medicine, National Medical Center
  • 2Department of Radiology, National Medical Center
  • 3Department of Surgery, National Medical Center
  • 4Szent László Hospital

The Crohn's disease of the 63 years old male was known for decades. Due to his disease bowel resection had been made. Following a long period free of complaints, significant weight loss and anemia developed. As etiologic factors the recrudescence of Crohn's disease, pulmonary tuberculosis and hyperthyroidism caused by nodular goiter were taken into account.

The relapse of Crohn's disease and tuberculosis could be excluded. Due to the patient's significant malnutrition artificial nutrition was introduced. Hyperthyroidism was confirmed, which transitionally improved after the implementation of methimazole therapy. Abdominal ultrasound imaging implied multifocal liver lesions. Primary malformation could not be identified. After guided liver biopsy, histologic examination could not prove malformation or metastasis, however showed inflammatory signs.

In the course of control examinations performed because of the deterioration of the patient's state of health, abdominal ultrasound showed significant growth of the intrahepatic lesions with central loose regions. In pursuance of rebiopsy of the liver pus discharged from the lesions, in which amoeba antigen could be detected. The multiplex amoebic liver abscesses infected by a streptococcus subspecies were treated by rebiopsies, by the installation of a permanent drain and by administration of parenteral ceftriaxon/metronidazole/ piperacillin/ tazobactam, the patient's state of health was improved by supportive artificial nutrition. Besides the detailed treatment significant clinical and ultrasonic amelioration started. During the follow-up of the patient, abdominal ultrasound imaging had an essential role.

Conclusions: The amoebic liver abscess is a rare entity in our country, but our patient's case showed, that it could be found in or can be caused by chronic, devastated states. During the examination of defined hepatic lesions, ultrasound follow-up and guided (if necessary repeated) biopsies are of great importance.