Liver Abscess Secondary to Ascaris Lumbricoides: Case Report

Background: Ascaris lumbricoides is one of the most frequent human helminthiasis, but the complication with liver abscess is very rare and severe, being a challenge for the correct and timely diagnosis. Case: A male of 62-years-old was brought to emergency room of a rural hospital referring one week of evolution with abdominal pain in right upper quadrant and epigastrium, with fever about 39ºC the last  three days, anorexia, asthenia, adinamia, diarrhea, and mental status deterioration the last 24 hours. At physical exam with Glasgow 11, dehydrated, with tachycardia or tachypnea, abdominal pain in right upper quadrant and epigastrium, without rebound, and with normal bowel sounds. Laboratories report leucocytes 29300 cell/mm3, neutrophils 80%, eosinophils 8%, Hemoglobin 9.5 mg/dL, Glucose 144mg/dL, Creatinine 2, total bilirubin 2.3, indirect bilirubin 1.9, ast 124 alt 112 ggt 193. A hepatic amebian abscess is suspected and empirical management with liquids, ceftriaxone and metronidazole was started. Patient continue with fever and disturbed mental status for the next two days. Ultrasound reports hepatomegaly related with liver abscess located in left lobe, with heterogeneous echogenicity secondary to hypoechoic images, rounded, well-defi ned, displacing hepatic vessels with tubular images inside. Albendazol was added to management and after two days, by the continued bad evolution CT scan was requested and report multiple liver abscesses in left lobe, segment II and III, the biggest of 68x60mm, with 16 Hounsfi eld units. An exploratory laparotomy was performed fi nding multiple encapsulated abscesses with the presence of Ascaris lumbricoides inside that were drain and after washing an open drain was placed. Patient presents signifi cant improvement with continued medical management and was discharged 7 days after surgery. Conclusion: This is a very uncommon complication of Ascaris lumbricoides infection but must be suspected and treated promptly by the severe consequences associated, with poor outcomes although correct management.