Unusual multiple large abscesses of the liver: interest of the radiological features and the real-time PCR to distinguish between bacterial and amebic etiologies

Abstract

We report a rare case of amebiasis generating 19 large liver abscesses. Such a quantity of abscesses is rare, especially when occurring in a young casual traveler without any immunodeficiency disorders. A possible co-infection was excluded. By contrast, the amebic etiology was confirmed by means of serology and real-time PCR.

Keywords: Amebiasis,; Computed tomography,; Entamoeba histolytica,; Multiple abscesses,; PCR.

Figure 1

Abdominal ultrasonography showing multiple rounded hypoechoic lesions.

Figure 2

Abdominal-computed tomography (CT) portal-phase showing large hypodense abscesses in all the hepatic segments (helical acquisition; dose length product  =  3494 mGy/cm; IV injection of 140 ml iohexol, Omnipaque 350^®). The 19 abscesses are individually labeled by large arrows. Edges were irregular, and the content appeared fluid and heterogeneous.

Figure 3

Computed tomography (CT)-guided aspiration of one of the more accessible abscess showing a sterile brown-purulent liquid. The punctured abscess was located under the capsule in the hepatic segment VI, and initially measured 78×54×80 mm. (A) The aspiration was performed laterally by the means of a trocar (large yellow arrow <$>\vskip-1\scale 80%\raster="rg1"\<$>). (B) The color of the 250 ml harvested fluid appeared macroscopically similar to milk chocolate. (C) The light microscopic observation showed only purulent material with a few degranulated leukocytes (→) and some altered red blood cells (→), but no viable Entamoeba histolytica trophozoites (magnification ×400).