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 abdomen and features of peritonitis/empyema/septicemia with a gravid uterus make diagnosis and management very challenging and require tailor-made descision plans. Drainage is also difficult as the uterus pushes the liver up giving only a small window for intervention. Superimposed pyogenic infection may also be there, which may be missed. Conclusion: Giant Amoebic liver abscesses in pregnancy, though potentially serious, can be effectively managed with early diagnosis and appropriate medical therapy. Multidisciplinary team approach should be considered. This case emphasizes the need for heightened clinical suspicion and tailored treatment strategies to prevent complications.

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