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First case of amebic liver abscess 22 years after the first occurrence - PubMed

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First case of amebic liver abscess 22 years after the first occurrence

Benoît Nespola et al. Parasite. 2015.

Abstract

A 72-year-old man consulted in November 2012 for abdominal pain in the right upper quadrant. The patient had a history of suspected hepatic amebiasis treated in Senegal in 1985 and has not traveled to endemic areas since 1990. Abdominal CT scan revealed a liver abscess. At first, no parasitological tests were performed and the patient was treated with broad-spectrum antibiotics. Only after failure of this therapy, serology and PCR performed after liver abscess puncture established the diagnosis of hepatic amebiasis. The patient was treated with metronidazole and tiliquinol-tilbroquinol. Amebic liver abscess is the most frequent extra-intestinal manifestation. Hepatic amebiasis 22 years after the last visit to an endemic area is exceptional and raises questions on the mechanisms of latency and recurrence of these intestinal protozoan parasites.

Un homme de 72 ans consulte en novembre 2012 pour des douleurs abdominales dans le quadrant supérieur droit. Le patient présente un antécédent probable d’abcès amibien du foie traité en 1985 au Sénégal et n’a pas voyagé en région d’endémie depuis 1990. Le scanner abdominal réalisé met en évidence un abcès hépatique. Dans un premier temps, aucun examen parasitologique n’est effectué et le patient est traité par des antibiotiques à large spectre. Suite à l’échec de ce traitement, la sérologie et la PCR réalisées après ponction de l’abcès hépatique, établissent le diagnostic d’amibiase hépatique. Le patient est traité par métronidazole et tiliquinol-tilbroquinol. L’abcès amibien du foie est la manifestation extra-intestinale de l’amibiase la plus fréquente. L’amibiase hépatique 22 ans après le dernier voyage en zone d’endémie est exceptionnelle et soulève des questions concernant les mécanismes de latence et de récurrence des protozoaires intestinaux.

© B. Nespola et al., published by EDP Sciences, 2015.

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Figures

Figure 1.
Figure 1.

Axial T2 weighted magnetic resonance cholangiopancreatography (MRC) images showing a voluminous and heterogeneous collection in the left liver lobe (amoebic abscess).

Figure 2.
Figure 2.

Coronal T2 weighted MRC images showing a voluminous and heterogeneous collection in the left liver lobe (amoebic abscess).

Figure 3.
Figure 3.

Three-dimensional (3D) MRC of the patient showing no bile duct dilatation.

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