A case of an amoebic liver abscess that was difficult to diagnose

Abstract

A 42-year-old man developed a high grade fever and abdominal pain. Abdominal US showed gallbladder swelling and increased wall thickness ; a low echoic area was noted in the liver in S5. Enhanced CT showed gallbladder swelling and a ring enhanced lesion in the liver in S5. A liver abscess was diagnosed, and percutanceous transhepatic abscess drainage was performed. A water-soluble contrast medium was infused through the catheter, and communication with the biliary tract was demonstrated. On microscopically, no echinococcus or Entamoeba histolytica was found in the abscess contents, and bacterial cultures were negative. A liver abscess secondary to the cholecystitis was diagnosed. Laparoscopic cholecystectomy was performed. On histology, no mucosal inflammation was noted in the resected specimen. Therefore, it was thought that the liver abscess had affected the gallbladder. After the operation, amoebic antibody testing was found to be positive, suggesting that the liver abscess was amoebic.