Charcot-Leyden Crystals in Hepatic Abscess: A Diagnostic Clue Unveiling Parasitic Infection Through Fine-Needle Aspiration Cytology

Charcot-Leyden crystals (CLCs) are hexagonal, colorless, bipyramidal structures derived from the aggregation of materials formed by disintegrating eosinophils. Necrotic cell debris and CLCs serve as indirect indicators of parasitic infestation. Here, we highlight a case of a 49-year-old male patient who presented with high-grade fever and right upper quadrant abdominal pain. Radiological findings showed a hypodense liver lesion consistent with an abscess. Fine-needle aspiration cytology (FNAC) demonstrated necrotic debris and a significant presence of CLCs, with no identifiable parasites. Laboratory investigations omitted bacterial and fungal infections, while enzyme-linked immunoassay (ELISA) identified IgG antibodies for <i>Entamoeba histolytica</i>. A definitive diagnosis of amoebic liver abscess was rendered, and the patient was treated successfully with metronidazole and luminal amoebicides. This case report emphasizes the diagnostic importance of CLCs in hepatic aspirates, particularly when the direct demonstration of parasites is a challenge. CLCs may provide indirect evidence of parasitic liver abscesses despite negative results from stool and cytological examinations for parasites. Effective identification and evidence-based anti-amoebic treatment are essential in endemic areas to avoid superfluous examinations for neoplastic causes.