Occult Amebic Liver Abscess as Cause of Extensive Inferior Vena Cava and Hepatic Vein Thrombosis

Leslie Martin Department of Medicine, McMaster University, Hamilton, Ontario, Canada;

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Nishigandha Burute Department of Radiology, McMaster University, Hamilton, Ontario, Canada;

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Ehsan Haider Department of Radiology, McMaster University, Hamilton, Ontario, Canada;

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Pablo E. Serrano Department of Surgery, McMaster University, Hamilton, Ontario, Canada;
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;

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Timothy O’Shea Department of Medicine, McMaster University, Hamilton, Ontario, Canada;

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Deborah Siegal Department of Medicine, McMaster University, Hamilton, Ontario, Canada;
Population Health Research Institute, Hamilton, Ontario, Canada

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DOI:
https://doi.org/10.4269/ajtmh.17-0258
Volume/Issue:
Volume 97: Issue 4
Page(s):
1214–1217
Restricted access
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The most common extraintestinal complication of Entamoeba histolytica is amebic liver abscess (ALA). Hepatic vein and inferior vena cava (IVC) thrombosis are rare but well-documented complications of ALA, typically attributed to mechanical compression and inflammation associated with a large abscess. We present a case of a previously healthy 43-year-old Canadian man presenting with constitutional symptoms and right upper quadrant abdominal pain. He was found to have thrombophlebitis of the IVC, accessory right hepatic vein, and bilateral iliac veins. Extensive investigations for thrombophilia were negative. Magnetic resonance imaging of the liver demonstrated a 3.2-cm focal area of parenchymal abnormality that was reported as presumptive hepatocellular carcinoma, and a 1.9-cm lesion in the caudate lobe with diffusion restriction and peripheral rim enhancement. Despite multiple biopsy attempts, a histopathological diagnosis was not achieved. Abdominal pain and fever 4 months later prompted repeat ultrasound demonstrating a 10.4- × 12.0-cm rim-enhancing fluid attenuation lesion felt to represent a liver abscess. Thick dark “chocolate brown” drainage from the lesion and positive serology for E. histolytica confirmed the diagnosis of ALA acquired from a previous trip to Cuba. The patient was started on treatment with metronidazole and paromomycin and repeat abdominal ultrasound demonstrated resolution of the abscess. This case is the first to demonstrate extensive IVC thrombosis secondary to a relatively small occult ALA and emphasizes the thrombogenic potential of ALA. Amebic infection should be considered as a rare cause of IVC thrombosis in the correct clinical context.

Author Notes

Address correspondence to Leslie Martin, Department of Medicine, McMaster University, St. Joseph's Healthcare, Fontbonne Bldg, F533, Hamilton, Ontario, L8N 2G9, Canada. E-mail: leslie.martin@medportal.ca

Authors’ addresses: Leslie Martin and Timothy O’Shea, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, E-mails: leslie.martin@medportal.ca and osheat@mcmaster.ca. Nishigandha Burute and Ehsan Haider, McMaster University, Department of Radiology, Hamilton, Ontario, Canada, E-mails: nishirad@gmail.com and ehaider@stjosham.on.ca. Pablo E. Serrano, Department of Surgery, McMaster University, Hamilton, Ontario, Canada, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada, E-mail: serrano@mcmaster.ca. Deborah Siegal, Department of Medicine, McMaster University, Hamilton, Ontario, Canada, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada, E-mail: deborah.siegal@medportal.ca.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2017
Received:
29 Mar 2017
|
Accepted:
14 May 2017
|
Published Online:
03 Jul 2017
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
  • 1.

    Haque R, Huston CD, Hughes M, Houpt E, Petri WA Jr, 2003. Amebiasis. N Engl J Med 348: 1565–1573.

  • 2.

    Stanley SL Jr, 2003. Amoebiasis. Lancet (London, England) 361: 1025–1034.

  • 3.

    Ray S, Khanra D, Saha M, Talukdar A, 2012. Amebic liver abscess complicated by inferior vena cava thrombosis: a case report. Med J Malaysia 67: 524–525.

    • Search Google Scholar
    • Export Citation
  • 4.

    McKenzie D, Gale M, Patel S, Kaluta G, 2015. Pulmonary thromboembolism complicating amebic liver abscess: first reported case in the united states-case report and literature review. Case Rep Infect Dis 2015: 516974.

    • Search Google Scholar
    • Export Citation
  • 5.

    Sodhi KS, Ojili V, Sakhuja V, Khandelwal N, 2008. Hepatic and inferior vena caval thrombosis: vascular complication of amebic liver abscess. J Emerg Med 34: 155–157.

    • Search Google Scholar
    • Export Citation
  • 6.

    Sarda AK, Mittal R, Basra BK, Mishra A, Talwar N, 2011. Three cases of amoebic liver abscess causing inferior vena cava obstruction, with a review of the literature. Korean J Hepatol 17: 71–75.

    • Search Google Scholar
    • Export Citation
  • 7.

    Siddiqui M, Gupta A, Kazmi A, Chandra D, Grover V, Gupta V, 2013. Inferior vena caval and right atrial thrombus complicating amoebic liver abscess. Interact Cardiovasc Thorac Surg 17: 872–874.

    • Search Google Scholar
    • Export Citation
  • 8.

    Khan S, Ameen Rauf M, 2009. Amoebic liver abscesses complicated by inferior vena cava and right atrium thrombus. Trop Doct 39: 177–180.

  • 9.

    Gupta A, Dhua AK, Siddiqui MA, Dympep B, Grover V, Gupta VK, Sen A, 2013. Inferior vena cava thrombosis in a pediatric patient of amebic liver abscess. J Indian Assoc Pediatr Surg 18: 33–35.

    • Search Google Scholar
    • Export Citation
  • 10.

    Okuda K, 2002. Obliterative hepatocavopathy-inferior vena cava thrombosis at its hepatic portion. Hepatobiliary Pancreatic Dis Int 1: 499–509.

    • Search Google Scholar
    • Export Citation
  • 11.

    Park HJ, Kim SH, Jang KM, Lee SJ, Park MJ, Choi D, 2013. Differentiating hepatic abscess from malignant mimickers: value of diffusion-weighted imaging with an emphasis on the periphery of the lesion. J Magn Reson Imaging 38: 1333–1341.

    • Search Google Scholar
    • Export Citation
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