Supra-Infected Hepatic and Renal Amebic Abscesses-A Case Report

We describe the case of a 69-year-old man referred from a nursing home facility for acute severe anemia. On presentation, the patient complained of fever, chills, and abdominal pain. Physical exam was significant for a fever of 103.8 F, pale conjunctivae, rales over the right lung base and direct tenderness to palpation overlying the right upper quadrant. Laboratory analysis revealed a normocytic normochromic anemia of 6.7 g/dL, leukocytosis of 17.2 K/μL, elevated creatinine and hepatic function panel with a urinalysis remarkable for turbid cloudy appearing urine, positive for leucocyte esterase and white blood cells. Abdominal Ultrasonography (US) and computed tomography (CT) of the abdomen and pelvis with contrast revealed a 9.2 cm in maximal diameter low-density collection in the posterior aspect of the right lobe of the liver contiguous with a 7.2 cm maximal diameter multi-loculated collection of the superior pole of the right kidney. CT guided drainage of the liver revealed anchovy paste like material and positive cultures for proteus mirabilis species were obtained from both the hepatic and renal foci. Serum entamoeba antibody testing for IgG was positive and intravenous metronidazole with oral iodoquinol was started. Ultimately the patient’s clinical status improved and he was subsequently discharged