Amoebic liver abscess in a COVID-19 patient: a case report

Abstract

Background Amoebiasis is a parasitic disease caused by Entamoeba histolytica, which affects people living in low- and middle-income countries and has intestinal and extraintestinal manifestations. To date, knowledge on coronavirus disease 2019 (COVID-19) coinfection with enteric parasites is limited, and E. histolytica coinfection has not been previously described. Here we present the case of a patient with COVID-19 who, during hospitalisation, presented a clinical picture consistent with an amoebic liver abscess (ALA). Case presentation A 54-year-old man, admitted as a suspected case of COVID-19, presented to our hospital with dyspnoea, malaise, fever and hypoxaemia. A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse-transcription polymerase chain reaction. After 7 days, he developed diarrhoea, choluria and dysentery. An abdominal ultrasound showed a lesion compatible with a liver abscess; stool examination revealed E. histolytica trophozoites, and additional serology for E. histolytica was positive. After 12 days of treatment with metronidazole, ceftazidime and nitazoxanide, the patient reported acute abdominal pain, and an ultrasound examination revealed free liquid in the abdominal cavity. An emergency exploratory laparotomy was performed, finding 3000 mL of a thick fluid described as “anchovy paste”. Computed tomography scan revealed a second abscess. He ended up receiving 21 days of antibiotic treatment and was discharged with satisfactory improvement. Conclusion Here we present, to the best of our knowledge, the first report of ALA and COVID-19 co-presenting. Based on their pathophysiological similarities, coinfection with SARS-CoV-2 and E. histolytica could change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.

Fulminant amoebic colitis co-infection in a patient with COVID-19

“…Conversely, a recent study14 found that co-infection with parasitic diseases appears to be associated with reduced severity in patient with COVID-19, suggesting that parasite-driven immunomodulatory responses may mute the hyperinflammation associated with severe COVID-19. Based on their pathophysiological similarities, co-infection with SARS-CoV-2 and E. histolytica might change the patient’s clinical course; however, larger studies are needed to fully understand the interaction between these pathogens.…”

“…Maricuto et al 14 have hypothesised that elevated PGE2 levels are secondary to both direct stimulation of cyclo-oxygenase-2 (COX-2) by SARS-CoV-2 and a COX-2-like protein present in E. histolytica trophozoites, which might influence the clinical course; however, the available evidence remains insufficient to establish any correlation.…”

Discovering common pathogenetic processes between tuberculosis and COVID-19 by bioinformatics and system biology approach

“…With regard to liver abscess, COVID-19 and TB patients commonly experience gastrointestinal symptoms, night sweats, cough, and weight loss, all of which are associated with both liver abscess and TB. Notably, liver abscess has been reported in a COVID-19 patient [ 34 ].…”

Amebic liver abscess by Entamoeba histolytica

“…Recently, there has been a case reported of ALA copresenting with coronavirus disease 2019. Based on pathophysiological similarities, coinfection with both of these could affect the clinical course of the patient[ 18 ].…”