アメーバ性肝膿瘍を発症した男性同性愛者の1例

Abstract

We report a case of amoebic liver abscess in which the infection with Entamoeba histolytica (E.histolytica) was caused through homosexuality. The patient was a 51-year-old man who was married and had a daughter. He visited a doctor after enduring a fever for ten days. A blood examination disclosed leukocytosis with neutrophil prevalence (WBC 16600 /μl, 82% neutrophils) and abnormal liver function (AST 55 IU/ml, ALT 114 IU/ml, ALP 784 IU/ml). An abdominal ultrasonography revealed a space-occupying lesion (SOL) in the liver. He was admitted to our hospital for further evaluation. Magnetic resonance image demonstrated that the hepatic SOL was an abscess, 7cm in diameter. Chemotherapy with antibiotics, PIPC, and percutaneous transhepatic abscess drainage (PTAD) were immediately performed. E.histolytica was not detected in the drained effluent. Although those treatments seemed to be effective, a serological examination revealed that he was positive to E. histolytica. Repeated interviews clarified homosexuality, and the re-examination of the effluent in PTAD duct demonstrated an amoebic form of E.histolytica. The patient was successfully treated with metronidazole and discharged on the 31st hospital day. In diagnosing the hepatic amoebasis, serological examination is greatly useful, specially when the detection of E.histolytica has been unsuccessful.