Case Study of Patient with Liver abscess and Hypereosinophilia

Abstract

        Liver abscess with peripheral hypereosinophilia, now is increasing in numbers, to give the specific parasite is difficult. Objective of this article is to report a middle-aged thai female had abdominal pain in right upper quardrant and lost her weight about 5 kg. in 1 month and CT abdomen suspected hypovascular HCC or cholangiocarcinoma but the results of tumor marker were negative. The liver biopsy revealed chronic granulomatous inflammation, no malignancy. From history and laboratory investigations did not show malignancy, combined with peripheral hypereosinophilia, so the first CT abdomen was reviewed again. We found the peripheral tortuous serpiginous track which hepatic fascioliassi should be the primary diagnosic consideration. The patient was trated with triclabendazole 10 mg/kg for 1 dose, her symptoms were improved. CBC showed decreasing in eosinophilic count from 20.7% to 11.4% and the shrinkage of abscess from 10 cm. to 4 cm. was occurred. In the conclusion, if unidentified specific parasite, CT abdomen reveal peripheral tortuous serpiginous track, hepatic fascioliasis should be the primary diagnostic consideration, principle treatment is triclabendazole, and should follow the patient until the lesion is disappeared from the imaging.