Amoebic liver abscess: a diagnostic dilemma in the elderly

Abstract

A 63-year old man presented with a 2-year history of progressive abdominal swelling with non-specific symptoms and signs. He visited several hospitals, where no diagnosis could be made for about 2 years and all therapeutic options given were ineffective. The appearance of an elevated right hemi diaphragm on chest X-ray, a single well defined area of Sonolucency with a thin edged border on ultrasound and a positive amoebic precipitin led to a diagnosis of amoebic liver abscess. Radiological intervention through ultrasound guided aspiration combined with medical therapy using metronidazole, led to rapid recovery and near complete resolution. This case typifies a not very uncommon but atypical presentation of amoebic liver abscess seen in practice characterized by intra abdominal space occupying lesion with non-specific symptoms and signs. Effective use of imaging techniques should help in the diagnosis. Ultrasound guided aspiration combined with medical therapy is effective treatment.


Keywords: Amoebic liver abscess, atypical presentation, imaging


Annals of African Medicine Vol.2(1) 2003: 33-35