Photo Quiz: A 22-Year-Old with Abdominal Pain.

Abstract

A 22-year-old female presented with abdominal pain and discomfort for the previous 2 months in the right hypochondriac region along with complaints of low-grade fever (99 to 100°F) for the past 3 days. There was no history of jaundice, vomiting, change in bowel habits, or any other known illnesses. She has never travelled outside her homeland, India. The patient has been an animal lover and had been engaged in feeding stray animals (mainly dogs) since her childhood. On clinical examination, the abdomen was soft, nontender with no distension. Her complete blood counts were within normal limits, with total leukocyte count of 10,690/μL (reference range, 4,000 to 11,000/μL), differential leukocyte count with 57% neutrophils (reference range, 40 to 80%), 19.2% lymphocytes (reference range, 20 to 40%), 6.6% monocytes (reference range, 2 to 10%), and 0.5% basophils (reference range, 0 to 1%) with increased eosinophils of 16.7% (reference range, 1 to 6%). Her hemoglobin level was 7.8 g/dL (reference range, 12.0 to 15.0 g/dL). Considering her chief complaint, ultrasonographic examination of the abdomen was performed and revealed cysts in both lobes of the liver with no perihepatic collection or ascites. Cyst fluid obtained by ultrasound-guided aspiration was sent for microbiological investigations, and the findings observed on microscopic examination are shown in Fig. 1.