Primary Pulmonary Amebiasis Complicated with Multicystic Empyema

Abstract

Amebiasis is a parasitic infection caused by the protozoan Entamoeba histolytica. While most infections are asymptomatic, the disease could manifest clinically as amebic dysentery and/or extraintestinal invasion in the form of amebic liver abscess or other more rare manifestations such as pulmonary, cardiac, or brain involvement. Herein we are reporting a case of a 24-year-old male with history of Down syndrome who presented with severe right side pneumonia complicated with multicystic empyema resistant to regular medical therapy. Further investigation revealed a positive pleural fluid for E. histolytica cysts and trophozoites. The patient was diagnosed with primary pleuropulmonary amebiasis and he responded promptly to surgical drainage and metronidazole therapy. In patients from endemic areas all physicians should keep a high index of suspicion of amebiasis as a cause of pulmonary disease.

Figure 1

(a) Preoperative chest X-ray shows right sided obliteration of costophrenic angle and displaced right lung. (b) Postoperative resolution of the empyema (note chest tube).

Figure 2

Chest CT scan right sided pleural effusion with pocket mainly in lateral aspect and in the oblique fissure, multiple gas bubbles with air fluid levels (black arrow), and partial atelectasis of right middle and lower lobes that are medially displaced (white arrow).