McKenzie Devon, Gale Michael, Patel Sunny, Kaluta Grazyna
Department of Internal Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA.
Department of Internal Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA ; Department of Infectious Disease, Department of Medicine, New York University School of Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA.
Case Rep Infect Dis. 2015;2015:516974. doi: 10.1155/2015/516974. Epub 2015 Jul 30.
Even in the absence of Amebic colitis, Amebic liver abscess (ALA) is the most common extraintestinal complication of Entamoeba histolytica infection. In the USA, it is most prevalent in middle aged immigrant males from endemic countries such as Africa, Mexico, and India. One of the complications of ALA is inferior vena cava (IVC) thrombosis, which is believed to result from the mechanical compression of the IVC and the consequent thrombogenic nidus elicited from the resultant inflammatory response. There are very few reported cases and even fewer in which the thrombus became a harbinger to pulmonary thromboembolism. We present the case of a 43-year-old male from West Africa who presented with the chief complaint of right upper quadrant abdominal pain for one week associated with persistent nonproductive cough. He had a positive serum Entamoeba histolytica antibody with CT scan findings of a hepatic abscess with thrombosis of the hepatic vein and inferior vena cava and numerous bilateral pulmonary emboli. This amebic liver abscess was successfully treated with metronidazole and paromomycin, whereas the pulmonary thromboembolism was managed with medical anticoagulation. Based on current knowledge, this is the first reported case in the USA.
即使没有阿米巴结肠炎,阿米巴肝脓肿(ALA)也是溶组织内阿米巴感染最常见的肠外并发症。在美国,它在来自非洲、墨西哥和印度等流行国家的中年移民男性中最为普遍。ALA的并发症之一是下腔静脉(IVC)血栓形成,据信这是由于IVC受到机械压迫以及由此产生的炎症反应引发的血栓形成病灶所致。报道的病例非常少,而血栓成为肺血栓栓塞先兆的病例更少。我们报告了一例来自西非的43岁男性病例,其主要症状为右上腹腹痛一周,并伴有持续性干咳。他的血清溶组织内阿米巴抗体呈阳性,CT扫描显示肝脓肿伴肝静脉和下腔静脉血栓形成以及大量双侧肺栓塞。该阿米巴肝脓肿经甲硝唑和巴龙霉素成功治疗,而肺血栓栓塞则采用药物抗凝治疗。根据目前的知识,这是美国首例报告病例。