Amoebic liver abscess with lung involvement in paediatric

Abstract

Background: There are few reports of amoebic liver abscess in children, and the disease is life-threatening. It can rupture into the pleura to cause acute respiratory distress. Pulmonary amoebiasis, the second most common extra-intestinal pattern of infection, is frequently associated with amoebic liver abscesses. Case Description: We reported a case of amoebic liver abscess with lung involvement in a 10 y old Malaysian boy who presented with prolonged fever, lethargy, diarrhea, and right hypochondriac pain. He was diagnosed with possible ruptured liver abscess. Intravenous Ceftriaxone and Metronidazole were commenced. No organism was isolated in Blood culture, and stool microscopic examination for ova and cyst was negative. Ultrasonography of abdomen revealed of peritoneal collection with amoebic liver abscess in the superolateral segment of right lobe of liver whereas ultrasonography of thoracic showed pleural effusion and collapsed consolidation of right lower lobe of lung. After two days of admission, he developed acute respiratory distress Abdominal and chest drainage were done. Pleural fluid microscopic examination revealed Trophozoite of Entamoeba histolytica. Patient responded well clinically after completed four ws of treatment of Metronidazole. Discussion: The role of microscopic stool examination is limited. In this case, only one sample of stool was sent, and a microscopic stool examination of the cyst was negative. In view of the difficulty in demonstrating the causative pathogen in a clinical specimen, serological methods play an important role in diagnosing amoebic liver abscess. If the patient had undergone drainage of the abscess surgically, the aspiration material could be sent for microscopic examination. In this case, the microscopic examination of pleural fluid revealed the trophozoite of Entamoeba histolytica. Ultrasonography is easy and very useful in making early diagnosis and treatment. Most uncomplicated amoebic liver abscesses can be treated successfully with amoebicidal drug therapy alone. However, such in this case, ruptured amoebic liver abscess with lung involvement, surgical drainage is needed. In this case, the patient was responded well after four ws of treatment of Metronidazole. Conclusion: A multidisciplinary approach, including a gastroenterologist, radiologist, surgeon, and laboratory, is crucial for early diagnosis and successful treatment of these curable infections to prevent further complications, which can compromise the patient's outcome.