Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report

Abstract

Background Infection with Entamoeba histolytica and associated complications are relatively rare in developed countries. The overall low prevalence in the Western world as well as the possibly prolonged latency period between infection with the causing pathogen and onset of clinical symptoms may delay diagnosis of and adequate treatment for amoebiasis. Amoebic liver abscess (ALA) is the most common extraintestinal manifestation of invasive amoebiasis. Pregnancy has been described as a risk factor for development of invasive amoebiasis and management of these patients is especially complex. Case presentation A 30-year-old Caucasian woman in early pregnancy presented to our emergency department with abdominal pain alongside elevated inflammatory markers and liver function tests. Travel history revealed multiple journeys to tropic and subtropic regions during the past decade and a prolonged episode of intermittently bloody diarrhea during a five month stay in Indonesia seven years prior to admission. Sonographic and magnetic resonance imaging revealed a 5 × 4 cm hepatic abscess. After ultrasound-guided transcutaneous liver drainage, both abscess fluids and blood cultures showed neither bacterial growth nor microscopic signs of parasitic disease. Serological testing confirmed an infection with Entamoeba histolytica, which was treated with metronidazole, followed by eradication therapy with paromomycin. Subsequent clinical, laboratory and imaging follow-up exams showed regression of the ALA. In addition, the pregnancy completed without complications and a healthy baby boy was born 7 months after termination of treatment. Conclusions This case of invasive amoebiasis in early pregnancy outside of endemic regions and several years after exposure demonstrates the importance of broad differential diagnostics in the context of liver abscesses. The complex interdisciplinary decisions regarding the choice of imaging techniques as well as interventional and antibiotic therapy in the context of pregnancy are discussed. Furthermore, we present possible explanations for pregnancy as a risk factor for an invasive course of amoebiasis.

Intestinal Parasitic Infections, Treatment and Associated Factors among Pregnant Women in Sao Tome and Principe: A Cross-Sectional Study

“…None of the pregnant women with S intercalatum infection took the recommended praziquantel (40 mg/kg), and two women were even inadequately treated with piperazine [20,32]. Similarly, pregnant women infected with E histolytica were not treated, even though amebiasis treatment should be warranted even in asymptomatic carriers, not only because of the potential of developing the invasive disease but also to diminish the spread of disease [7,52,53].…”

Amebic liver abscess by Entamoeba histolytica

“…The geographic distribution of amebiasis has worldwide amplitude and a high rate of incidence, and it remains a public health concern in low- and middle-income developing countries in the tropics, particularly in environments that are crowded and lacking in adequate sanitation and clean water due to the oral-fecal route of pathogen transmission (including ingestion of food or water that contains cysts from this protozoan)[ 6 , 16 - 19 ]. On the other hand, this pathogen is only rarely seen in wealthier countries but is epidemiologically growing; in particular, recent immigrants from endemic regions (or travelers returning from a long-term stay in an endemic region) have a greater risk of developing amebiasis[ 6 , 20 - 22 ].…”

“…In the Western world, the low overall prevalence, as well as the fact that the latency period between infection by the underlying pathogen and clinical symptom onset may be lengthy, creates a risk of delaying diagnosis of amebiasis and thus inadequate treatment[ 20 ]. Additionally, pregnancy has also been found to be an invasive amebiasis risk factor; management of pregnant patients becomes especially complex[ 20 ]. Mortality due to amebiasis is primarily the result of extraintestinal infections, with the most common of these being ALAs[ 25 ].…”

Amoebic liver abscess in a patient from Gambia

“…La presentación clínica de absceso hepático generalmente ocurre dentro de las 8 a 20 semanas post-infección, aunque puede ser asintomático durante años [ 5 ]. Suele aparecer dolor en hipocondrio superior derecho, fiebre y hepatomegalia.…”