S2638 Hepatic Abscess Secondary to Entamoeba Histolytica Reactivated in a Patient After Infection With COVID-19

Abstract

Introduction: Coronavirus disease 2019 (COVID-19) is known to cause a broad spectrum of illnesses. To date there are several studies demonstrating bacterial and fungal coinfection among COVID-19 positive individuals. There is limited research regarding the relationship between COVID-19 and parasitic coinfection. This case report describes the clinical features of fulminant amebiasis infection in an individual who received corticosteroids for superimposed COVID-19 infection. Case Description/Methods: We present a 79-year-old Filipino female with no significant past medical history admitted for generalized weakness and shortness of breath. Physical exam was unremarkable. Blood work was significant for:Hemoglobin (Hbg):11.2 g/dL, Hematocrit (Hct):34%, Na:120 mmol/L. Patient was found to be COVID positive. Patient received supplemental oxygen, Remdesivir, and Dexamethasone 20mg twice daily for 10 days. On day 10, she became hypotensive and had an episode of melena. Computed tomography abdominal and pelvis (CTAP) showed a 8mm right hepatic lesion Figure 1(a). Patient was discharged in stable condition, but was readmitted 20 days later for presyncope. Temperature was 103, HR 111. Labs:WBC count: 22.46uL, Hbg:8.4g/dL, Na:127 mmol/L, K: 2.9 mmol/L. CTAP showed interval development of a large ring-enhancing collection in the right lobe of the liver measuring 7.2 x 7.4cm, Figure 1(b). Serology was positive for Entamoeba Histolytica. Patient was treated with Metronidazole and Cefepime. Abscess was drained by interventional radiology. Patient's clinical condition improved. Discussion: Amebiasis is a parasitic infection common in underdeveloped countries. Majority of patients with intestinal illness remain asymptomatic or present with nonspecific symptoms. Fulminant amebic colitis is the most devastating complication and associated with high mortality and morbidity. In this case, treatment of COVID-19 with high dose corticosteroids may have served as a predisposing factor in reactivation of amoebic infection. The main point of entry for SARS-CoV-2 is the respiratory system. During the early stages of the illness some patients experience gastrointestinal involvement. Intestinal dysfunction in COVID induces changes in intestinal microbes and an increase in inflammatory cytokines. Clinical suspicion for parasitic infection should be maintained in patients from endemic areas who develop sepsis. Prior to administering immunosuppressive therapy in COVID-19 patients from endemic areas, it may be beneficial to screen for parasites.Figure 1.: Fig. 1 (a,b) Ring enhancing hepatic lesion.