Case report – detection of simultaneous liver lesions: multiples hemangiomata and amoebiasis

Amoebiasis remains a significant cause of morbidity and mortality (up to 100,000 deaths/y worldwide). Amoebic liver abscess is the most common extra-intestinal manifestation.

We report a case of a 51-year-old male patient with a history of abdominal discomfort and abdominal bloating, weight lost and fever up to 39 °C. He has travelled in India for one week 4 months ago. Laboratory tests show increased CRP (221 mg/l) and leukocytosis (15.0 G/l) without eosinophilia. Liver and pancreatic enzymes were normal. Urinary, stool and blood cultures were negative for bacterial origines. Abdominal ultrasound showed several hyperechogenic hemangiomata (liver segments V, VI and VII) and a hypoechogenic lesion (liver segment 6), compatible with neoplasia, atypique hemangioma or abscess (Fig. 1). An abdominal MRI confirms the diagnosis of hemangiomata and suggested an liver abscess of 4,5 cm. Two serology tests (ELISA, IFAT) confirmed the diagnosis of amoebiasis. Treatment of metronidazole and paromomycine was initiated and the patient clinically recovered. Radiological control six months later showed a complete regression of the liver abscess.

Fig. 1

Conclusion:

Amoebiatic liver abscess is a potential complication of infection by entamoeba histolytica. The presence of simultaneous liver hemangiomata in our case was tricky, potentially leading to misunderstand the life-threatening diagnosis. Abdominal ultrasound and the travel history represent a key moment of the diagnostic process.