AN UNCOMMON CAUSE OF HEPATIC LESIONS

An uncommon etiology of intraabdominal abscesses presenting as appendicitis in a patient with travel exposure. A 52-year-old African-American male presented to the emergency department with four days of dull, achy abdominal pain, nausea, fever, and non-bloody diarrhea. The abdominal symptoms progressed as sharp and stabbing pain in the right upper and lower quadrants. He had remote history of being stationed in Panama with episodes of non-bloody diarrhea occurring intermittently for months since his return, with no clear etiology. He had a past medical history of diverticulosis and remote use of tobacco and alcohol abuse. Physical exam revealed a temperature of 103.4F, tachycardia, tachypnea and tenderness to palpation in right upper and lower quadrants with rebound, guarding and tenderness at McBurney's point. Laboratory tests revealed a leukocytosis with neutrophilia and bandemia, transaminitis, elevated alkaline phosphatase and hyperbilirubinemia. CRP and ES