Hepatic Amebiasis Simulating Pleural Effusion, Diagnostic Difficulties

Introduction: Hepatic amebiasis is a serious illness that can be life-threatening if not treated appropriately. It can be complicated by pleural effusion, which in some cases complicates the diagnosis. We report the case of a 43-year-old patient with hepatic amebiasis revealed by a pleural effusion. Observation: This 43-year-old patient was a known alcoholic and a 10-year tobacco addict who had not weaned himself off the 10 pack-year habit. He had no history of tuberculosis, and had been delirious for a month, after which an undocumented treatment had been prescribed. He was admitted to hospital with diffuse pain associated with a deterioration in general condition, including physical asthenia, non-selective anorexia and weight loss. He also had tenderness of the right hypochondrium in a context of intermittent fever, associated with chills and profuse sweating, all of which had been evolving for 1 month. On admission, physical examination revealed a right basal pleural effusion syndrome, a systemic inflammatory response syndrome, clinical anemia and altered general condition. Laboratory findings included hyponatremia, hyperleukocytosis with neutrophil predominance, normocytic anemia and increased C-reactive protein. Chest X-ray revealed a right basal pleural effusion, confirmed by computed tomography scan (CT scan), with the presence of a liver abscess. Amebic serology came back positive. Surgical drainage was performed, yielding brown pus. The patient was put on metronidazole. We noted a good clinical and biological evolution. Conclusion: Hepatic amebiasis is a rare but serious condition. It may complicate amebic dysentery. Hepatic amebiasis should be considered in patients with pleural effusion in endemic areas and an interdisciplinary approach. It requires appropriate treatment to prevent complications.