Hepatic Abscess in a Returning Traveler with Crohn's Disease: Differentiating Amebic from Pyogenic Liver Abscess

Abstract

Liver abscess is a rare but serious complication of Crohn's disease. Patients with Crohn's disease are at risk for pyogenic liver abscesses due to immunosuppressive therapy, fistulous disease, and intraabdominal abscesses. Inflammatory bowel disease patients are also known to have a greater prevalence of amebiasis compared to the rest of the population; however, a higher incidence of amebic liver abscess has not been reported. We describe a case of a liver abscess in a patient with Crohn's disease that was initially presumed pyogenic but later determined to be amebic in origin. Epidemiology, clinical presentation, diagnosis, and treatment of amebic and pyogenic liver abscesses are discussed.

Figure 1

Abdominal CT scan on hospital admission revealing a complex lower attenuating 6.0 cm hepatic segment 4A/B lesion with a thick marginal rim, adjacent parenchymal inflammation, and biliary prominence.

Figure 2

Abdominal CT scan 2 weeks after discharge demonstrating near total resolution of the previously seen hepatic segment 4 abscess without any drainable fluid collection.