Abstract

Introduction: Amoebic liver abscesses, primarily due to Entamoeba histolytica, are prevalent in tropical regions. Undetected, they can reach huge sizes causing febrile illness with features of acute abdomen. Early diagnosis and timely intervention are more crucial in pregnancy to prevent complications not only to mother (like rupture, sepsis and septic shock), but also to fetus. This case discusses the diagnostic and management problems in one such gravid woman with a gigantic Liver abscess presenting with sepsis. Case Presentation: We present a case of a 39 years, Primigravida at 33 weeks of gestation who presented to emergency with high grade fever, severe pain abdomen, abdominal distension, nausea-vomitting and constipation. She had a qSOFA score of 10 and was admitted in the ICU with Sepsis and Acute abdomen. Investigations revealed a Liver abscess of 1000cc in the left lobe. ICU management was done followed by percutaneous drainage of the abscess was done and patient was started on parenteral meropenem and metronidazole along with close feto-maternal monitoring. Serological tests confirmed Entamoeba histolytica. She was discharged with a healthy fetus after 9 days and sent home on Tab metronidazole. Discussion: This case highlights the importance of considering amoebic liver abscess in patients from endemic areas presenting with fever and right upper quadrant pain. Diagnostic imaging, combined with serology, plays a pivotal role in prompt diagnosis. Antiparasitic therapy remains the cornerstone of treatment, drainage can be considered to hasten the response specially in cases with large collection while other surgical interventions are kept for complicated cases. Acute

• 1.   Guy J & Peters M. Liver Disease in Women: The Influence of Gender on Epidemiology, Natural History, and Patient Outcomes. Gastroenterol Hepatol (N Y). 2013;9(10):633-9.
• 2.   Chiam KH, Lim YAL, Rohela M, Ngui R, Lee LL. Gigantic amoebic liver abscess in pregnancy: A case report. Trop Biomed. 2015 Dec 1;32(4):699-703. PMID: 33557461.
• 3.   Karadbhajne P, Tambekar A, Gaidhane A, Quaxi Syed Z, Gaidhane S, Patil M.Amoebiasis in Pregnant women: A Case Report. Medical Sciences. 2020, 24(104):1814-1817.
• 4.   Escola-Verge L, Arando M, Vall M, Rovira R, Espasa M, Sulleiro E, Armengol P, Zarzuela F, Barbera MJ. Outbreak of intestinal amoebiasis among men who have sex with men, Barcelona (Spain), October 2016 and January 2017. Euro Surveill. 2017;22:30.
• 5.   Ratnasamy V, Thirunavukarasu K, Selvam K, Arumugam M. Amoebic liver abscess: an unusual cause for a right iliac fossa mass: a case report. BMC Infect Dis. 2016 Dec
• 6.   Tharmaratnam T, Kumanan T, Iskandar MA, D'Urzo K, Gopee-Ramanan P, Loganathan M, Tabobondung T, Tabobondung TA, Sivagurunathan S, Patel M, Tobbia I. Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem. Trop Med Health. 2020 Jan 22;48:2. doi: 10.1186/s41182-020- 0193-2. PMID: 31992948; PMCID: PMC6977265.
• 7.   Anesi JA, Gluckman S. Amebic liver abscess. Clin Liver Dis (Hoboken). 2015;6(2):41–3.
• 8.   Kaiser, R.W.J., Allgeier, J., Philipp, A.B. et al. Development of amoebic liver abscess in early pregnancy years after initial amoebic exposure: a case report. BMC Gastroenterol20, 424 (2020). https://doi.org/10.1186/s12876-020-01567-7.
• 9.   Mabina, M.H., Moodley, J., Pitsoe, S.B., & Monokoane, S.T. (1998). Amoebic liver abscess in pregnancy: report of two cases. East African medical journal, 751, 57-60

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