Scandinavian Journal of Infectious Diseases, 2014; 46: 735–736
LETTER TO THE EDITOR
Scand J Infect Dis Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/13/14 For personal use only.
Misdiagnosed amoebiasis leading to liver abscess
MAŁGORZATA SULIMA1, WOJCIECH WOŁYNIEC2, WACŁAW LESZEK NAHORSKI1, DARIUSZ ZADROŻNY3, KRYSTYNA WITCZAK-MALINOWSKA1 & MARCIN RENKE2 From the 1Department of Tropical and Parasitic Diseases and 2Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, and 3Department of Surgery, Medical University of Gdansk, Gdansk, Poland
To the Editor, Mogensen et al. presented a case of amoebic colitis, misdiagnosed as inflammatory bowel disease [1]. At the Department of Tropical and Parasitic Disease (DTPD) in Gdynia, Poland, a similar misdiagnosis was recently disclosed. A 63-year-old man had developed his first symptoms in November 2013, during a journey to Gambia. After a 2 months duration of diarrhoea, abdominal pain and weight loss, the patient was hospitalized twice. Unfortunately, his travel history was then ignored. During the first hospitalization (20–27 January 2014) metronidazole (MTZ) was introduced with marked improvement. Nevertheless, MTZ was discontinued and steroids and mesalazine were prescribed based on colitis of unknown reason. CT showed thickening of the ascending colon with regional lymph node involvement. Diarrhoea, fever and abdominal pain reappeared soon after discharge. His general condition was deteriorating quickly. The patient was once again hospitalized (11–20 February 2014) and because the Clostridium difficile toxin stool test was positive steroids were withdrawn and MTZ was started. His general condition improved but pain in his right upper quadrant occurred. CT examinations revealed a lesion in the right lobe of the liver (Figure 1). The patient was referred to DTPD with suspicion of echinococcal cyst, which is the most common focal parasite liver lesion diagnosed in Poland [2]. The problem was that in a previous CT in January 2014 no cyst was
Figure 1. Abdominal CT performed in February 2014 revealed amoebic liver abscess localized in the right lobe of the liver (segment 6,7). The internal septations are noted.
present in the liver. This excluded hydatid disease, which needs more time to develop [2]. Amoebic liver abscess (ALA) was suspected on the basis of the patient’s history, symptoms and imaging studies. All typical symptoms of amoebic colitis, mainly bloody diarrhea, occurred [3–5]. The symptoms disappeared after administration of MTZ and reappeared after steroids. Finally, typical symptoms of ALA occurred. On CT scans it appeared as a rounded, low attenuation lesion (Figure 1). A serological test confirmed the diagnosis and the patient was successfully treated with MTZ and percutaneous abscess drainage.
Correspondence: Wojciech Wołyniec, MD, PhD, Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, ul. Powstania Styczniowego 9b, Gdynia, Poland. Tel: ⫹ 48 58 699 85 93. Fax: ⫹ 48 58 699 85 92. E-mail: [email protected] (Received 18 May 2014 ; accepted 1 June 2014 ) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2014.931598
736
M. Sulima et al.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
Scand J Infect Dis Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/13/14 For personal use only.
[1] Mogensen TH, Christiansen JJ, Eivindson MV, Larsen CS, Tøttrup A. Misdiagnosed amoebic colitis leading to severe dysentery and necrotizing colitis – report of a case and review of the literature. Scand J Infect Dis 2014;46: 235–9.
[2] Nahorski WL, Knap JP, Pawłowski ZS, Krawczyk M, Polański J, Stefaniak J, et al. Human alveolar echinococcosis in Poland: 1990-2011. PloS Negl Trop Dis 2013;7:e1986. [3] Cosme A, Ojeda E, Zamarreño I, Bujanda L, Garmendia G, Echeverría MJ, et al. Pyogenic versus amoebic liver abscesses. A comparative clinical study in a series of 58 patients. Rev Esp Enferm Dig 2010;102:90–9. [4] Wuerz T, Kane JB, Boggild AK, Krajden S, Keystone JS, Fuksa M, et al. A review of amoebic liver abscess for clinicians in a nonendemic setting. Can J Gastroenterol 2012;26:729–33. [5] Mukhopadhyay M, Saha AK, Sarkar A, Mukherjee S. Amoebic liver abscess: presentation and complications. Indian J Surg 2010;72:37–41.
LETTER TO THE EDITOR
Scand J Infect Dis Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/13/14 For personal use only.
Misdiagnosed amoebiasis leading to liver abscess
MAŁGORZATA SULIMA1, WOJCIECH WOŁYNIEC2, WACŁAW LESZEK NAHORSKI1, DARIUSZ ZADROŻNY3, KRYSTYNA WITCZAK-MALINOWSKA1 & MARCIN RENKE2 From the 1Department of Tropical and Parasitic Diseases and 2Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, Gdynia, and 3Department of Surgery, Medical University of Gdansk, Gdansk, Poland
To the Editor, Mogensen et al. presented a case of amoebic colitis, misdiagnosed as inflammatory bowel disease [1]. At the Department of Tropical and Parasitic Disease (DTPD) in Gdynia, Poland, a similar misdiagnosis was recently disclosed. A 63-year-old man had developed his first symptoms in November 2013, during a journey to Gambia. After a 2 months duration of diarrhoea, abdominal pain and weight loss, the patient was hospitalized twice. Unfortunately, his travel history was then ignored. During the first hospitalization (20–27 January 2014) metronidazole (MTZ) was introduced with marked improvement. Nevertheless, MTZ was discontinued and steroids and mesalazine were prescribed based on colitis of unknown reason. CT showed thickening of the ascending colon with regional lymph node involvement. Diarrhoea, fever and abdominal pain reappeared soon after discharge. His general condition was deteriorating quickly. The patient was once again hospitalized (11–20 February 2014) and because the Clostridium difficile toxin stool test was positive steroids were withdrawn and MTZ was started. His general condition improved but pain in his right upper quadrant occurred. CT examinations revealed a lesion in the right lobe of the liver (Figure 1). The patient was referred to DTPD with suspicion of echinococcal cyst, which is the most common focal parasite liver lesion diagnosed in Poland [2]. The problem was that in a previous CT in January 2014 no cyst was
Figure 1. Abdominal CT performed in February 2014 revealed amoebic liver abscess localized in the right lobe of the liver (segment 6,7). The internal septations are noted.
present in the liver. This excluded hydatid disease, which needs more time to develop [2]. Amoebic liver abscess (ALA) was suspected on the basis of the patient’s history, symptoms and imaging studies. All typical symptoms of amoebic colitis, mainly bloody diarrhea, occurred [3–5]. The symptoms disappeared after administration of MTZ and reappeared after steroids. Finally, typical symptoms of ALA occurred. On CT scans it appeared as a rounded, low attenuation lesion (Figure 1). A serological test confirmed the diagnosis and the patient was successfully treated with MTZ and percutaneous abscess drainage.
Correspondence: Wojciech Wołyniec, MD, PhD, Department of Occupational and Internal Medicine, Institute of Maritime and Tropical Medicine, Medical University of Gdansk, ul. Powstania Styczniowego 9b, Gdynia, Poland. Tel: ⫹ 48 58 699 85 93. Fax: ⫹ 48 58 699 85 92. E-mail: [email protected] (Received 18 May 2014 ; accepted 1 June 2014 ) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2014.931598
736
M. Sulima et al.
Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References
Scand J Infect Dis Downloaded from informahealthcare.com by QUT Queensland University of Tech on 10/13/14 For personal use only.
[1] Mogensen TH, Christiansen JJ, Eivindson MV, Larsen CS, Tøttrup A. Misdiagnosed amoebic colitis leading to severe dysentery and necrotizing colitis – report of a case and review of the literature. Scand J Infect Dis 2014;46: 235–9.
[2] Nahorski WL, Knap JP, Pawłowski ZS, Krawczyk M, Polański J, Stefaniak J, et al. Human alveolar echinococcosis in Poland: 1990-2011. PloS Negl Trop Dis 2013;7:e1986. [3] Cosme A, Ojeda E, Zamarreño I, Bujanda L, Garmendia G, Echeverría MJ, et al. Pyogenic versus amoebic liver abscesses. A comparative clinical study in a series of 58 patients. Rev Esp Enferm Dig 2010;102:90–9. [4] Wuerz T, Kane JB, Boggild AK, Krajden S, Keystone JS, Fuksa M, et al. A review of amoebic liver abscess for clinicians in a nonendemic setting. Can J Gastroenterol 2012;26:729–33. [5] Mukhopadhyay M, Saha AK, Sarkar A, Mukherjee S. Amoebic liver abscess: presentation and complications. Indian J Surg 2010;72:37–41.
