Amoebic Liver Abscess in 13 Y/O/M: Case Report
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A 13 year old boy was referred with chief complaint of intermittent abdominal pain on right side since 8 days. Patient complained of fever, breathlessness, loss of appetite and watery stools. He also felt stomach getting bigger in size since 3 days.

The patient had been given therapy with IVFD IB 20tpm, meropenem 3x450 mg iv, ceftriaxone 2x1 g iv, ranitidine 2x50mg iv, tofedex 1x50mg iv, vitagrow syrup 1 time per day. On examination of lungs there was decreased tactile fremitus in the right side, minimal dullness to percussion in hemithorax dextra. Breathsound was decreased from intercostal space VI hemithorax dextra. Liver was palpable 2/3 – 2/3, with sharp edge and flat consistency. There was tenderness at right upper abdomen. Laboratory results revealed SGOT: 427, SGPT: 248. Abdominal ultrasound was performed with result of suggestive liver abscess on right lobus, cholesistitis, right pleural effusion, minimal acscitess in cavum pelvis.

Abdominal CT-Scan showed enlarged liver and spleen, with homogeneous density, hypodens lessions at right lobe of liver, indefinite boundary, irreguler borders, size 10.25cm x 10.96cm x 11cm. There was no ascites. There was right pleural effusion. The conclusion was it suited right lobe liver abcess and right pleural effusion. Serology found anti amoeba positive (33,2 U). Patient was treated with solid food hepatic diet 2.000 kkal, metronidazol 3x400mg iv, ceftriaxone 2x1 gr iv Kcl 3x500mg po, calc 2x500mg. The patient was consulted for undergoing abcess drainage.

From the analysis of parasitological abscess, Entamoeba histolytica was found in thick reddish white abscess with microscopic cellular debris, PMN with a background of amorphous mass. Post drainage, patient planned transfussion PRC 200cc. Since then he is in stable condition, and got discharged after 20 days of hospitalization.

Hepatic abscess treatment still raises much controversy as to the desirability of antibiotic therapy alone as well as the choice of antibiotics or the place of drainage or percutaneous evacuating puncture in relation to surgery.

Source: http://journal.iipch.org/ijcpch/article/view/20/21
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