Matthew M. Barvo, MD1, Moiz Javed, MD1, Mohammad Wajid Hussain, MBBS1, Phillip Leff, DO2, Brett A. Dinner, MD1, Robert Lee, MD1, Mark Macelwee, MD3 1Creighton University, Phoenix, AZ; 2Creighton University, Scottsdale, AZ; 3Valleywise Health Medical Center, Phoenix, AZ
Introduction: The most common location for extra-intestinal manifestation of Entamoeba infection is the liver, and is the fourth leading cause of parasitic mortality worldwide. This case reports documents the diagnosis of a large Entamoeba liver abscess, and the novel administration of TPA solution to resolve the infection.
Case Description/Methods: A 50-year-old gentleman with a history of alcohol and IV drug use presented to the ED with symptoms of abdominal pain, nausea, vomiting, fever, and chills. He was tachycardic, with leukocytosis, and elevated lactic acid, however his liver enzymes remained within normal limits. A CT scan of the abdomen showed a complex hepatic mass measuring 4.5 cm, suggestive of necrotic malignancy vs abscess. Antibiotics were initiated. Interventional radiology team was consulted, placing a drain into the hepatic abscess. Unfortunately, the drain output was minimal. Lab testing returned positive for Entamoeba histolytica. Due to the low output from the drains, the patient received six doses of tissue plasminogen activator (tPA) to promote drain patency and facilitate drainage. The tPA treatment resulted in improvement, and a repeat CT scan showed a near-resolution of the abscesses. Eventually, the drains were removed and the patient was discharged home with a one-week course of Levaquin and a six-week course of Flagyl.
Discussion: Hepatic Amoebiasis is commonly seen in patients visiting from endemic areas such as India, Africa, Mexico and parts of Central/South America. Patients generally present with persistent right upper quadrant pain, fever, diaphoresis, malaise, hiccups, and weight loss. A serious complication of Amoebic liver abscess is rupture leading to peritonitis, or hepatic/IVC thrombosis. The antibiotic of choice is generally Metronidazole, and large liver abscesses may require drainage. We document a case of large liver abscess requiring drain placement, and the successful utilization of a specially formulated tPA solution to effectively resolve the infection.
Figure: 4.5cm Liver abscess before administration of TPA, improved to 3.4cm following TPA
Matthew Barvo indicated no relevant financial relationships.
Moiz Javed indicated no relevant financial relationships.
Mohammad Wajid Hussain indicated no relevant financial relationships.
Phillip Leff indicated no relevant financial relationships.
Brett Dinner indicated no relevant financial relationships.
Robert Lee indicated no relevant financial relationships.
Mark Macelwee indicated no relevant financial relationships.
Matthew M. Barvo, MD1, Moiz Javed, MD1, Mohammad Wajid Hussain, MBBS1, Phillip Leff, DO2, Brett A. Dinner, MD1, Robert Lee, MD1, Mark Macelwee, MD3. P1022 - A Novel Approach in the Treatment of Entamoeba Liver Abscess, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.