Relapse of Intestinal and Hepatic Amebiasis After Treatment
Stanford Multidisciplinary Seminars
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Case Presentation and Evolution
Six months after returning from a trip to Hawaii, a previously healthy 63-year-old man presented with 5 months of right upper-quadrant abdominal pain and non-bloody diarrhea, 3 months of nausea and non-bloody vomiting, and 1 month of fevers, chills, night sweats, and anorexia, culminating in a loss of 20 lbs. Comprehensive laboratory tests were notable for leukocytosis with a white blood cell (WBC) count of 11,300/mm 3 with 88% neutrophils, elevated liver chemistry tests (total bilirubin 0.6 mg/dl, aspartate aminotransferase [AST] 64 U/l, alanine aminotransferase [ALT] 92 U/l, and alkaline phosphatase 674 U/l), and renal failure (blood urea nitrogen 57 mg/dl, creatinine 2.3 mg/dl). Due to his renal insufficiency, non-contrast imaging of the abdomen was obtained, which revealed a 12-cm, thick-walled, multiloculated cystic lesion in the right lobe of the liver (Fig. 1a). Cultures obtained from the patient’s blood, stool, and fluid aspirated from the liver...
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