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Amebic Liver Abscess Complicated by Bilateral Adrenal Hemorrhage and ...

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Topic: Amebic liver abscess
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Sort Desciption: Liver abscess is the most common extraintestinal complication of infection with Entamoeba histolytica. Although spontaneous bilateral adrenal hemorrhage may occur in the setting of any severe illness, ...

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Liver abscess is the most common extraintestinal complication of infection with Entamoeba histolytica. Although spontaneous bilateral adrenal hemorrhage may occur in the setting of any severe illness, only rarely has it been associated with amebic liver abscess. 1 This article describes a 70-year old man who presented with an amebic liver abscess and who developed bilateral adrenal hemorrhage and adrenal insufficiency. The diagnosis and treatment of both amebic liver abscess and spontaneous bilateral adrenal hemorrhage are reviewed. CASE PRESENTATION A 70-year-old man was transferred to our institution (a 1200-bed tertiary care center) for further evaluation of a febrile illness of unknown origin. Over a period of 4 months, the patient had noticed progressive fatigue and lightheadedness. Three weeks prior to transfer, he began having intermittent fevers (up to 102.1°F), shaking chills, and soaking night sweats. He had been treated at home with several courses of oral antibiotics (amoxicillin, ciprofloxacin) and for 3 days with intravenous imipenemall of which failed to relieve his symptoms. History His past medical history was remarkable only for retinal detachment in his right eye and an anaphylactic reaction to bee stings. He was allergic to sulfa drugs and was on no medications. He denied any recent travel outside of the United States, although he wintered in Scottsdale, Arizona. He had not experienced nausea, vomiting, or diarrhea. Physical Examination On physical examination, the patient was shivering in bed with a body temperature of 99.6°F. His blood pressure was 150/90 mm Hg. His pulse was 80 bpm, and his respiratory rate was 24 breaths/min. Abdominal examination revealed neither hepatosplenomegaly nor abdominal tenderness. The remainder of the physical examination was unremarkable. Laboratory and Radiographic Evaluation Admission laboratory tests showed the following ...

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