Case
PARASITIC LIVER ABSCESS CAUSED BY ASCARIS LUMBRICOIDES

Age: 50 yrs.
Sex: Male
Race: Bangladeshi;Caucasian;Southeast Asian

History
History of present illness:
Chronic illness of six months duration with weight loss, cough and abdominal pain in the upper right half associated with constipation.

Medical History:
Not significant

Past surgical history:
None

Allergies:
None

Medications:
None

Family history:
Not significant

Social history:
Patient comes from rural area of Bangladesh. Socioeconomic condition is poor.


Physical Exam
General:
Patient had mild fiver and tachycardia. He appeared severely anaemic, no visceral enlargement was found but abdominal tenderness was present in right hypochondriac region.

Temperature:
99 degree Farenheit

Heart rate:
110/min

Blood pressure:
120/75 mm Hg

Respiratory rate:
19/min

Oxygen saturation:
Not detected

Head, ears, eyes, nose & throat:
No abnormality detected.

Neck:
No abnormality detected.

Chest:
Tenderness at lower part of right anterior chest.

Cardiovascular:
No abnormality detected.

Abdomen:
Tenderness at right hypochondriac region.

GU:
No abnormality detected.

Rectal:
No abnormality detected.

Neurological:
No abnormality detected.

Skin:
No abnormality detected.

Laboratories:
Hb: 5.8 g/dl, erythrocyte sedimentation
rate: 130 mm in the first 1 h, leukocyte count: 10,500/ml, neutrophils:
67%, lymphocytes 20%, monocytes 2%, eosinophils: 11%; Widal test titre: within normal limit, DAT for Kala-azar: Negative. Total bilirubin 0. 7 mg/dl; direct bilirubin: 0.2 mg/dl. AST: 38 IU/L, ALT: 41 IU/L,
alkaline phosphatase 102 mg/dl. Stool examination: Occasional ova of Ascaris Lumbricoides. kidney function tests: within normal limirt.

Radiology:
Chest skiagram revealed mild right sided pleural effusion.

Other:
Ultrasound study revealed an irregular outlined hypo echoic lesion, 6 cm in diameter, located in the extreme superior aspect of the lateral part of the right lobe.The liver was however not enlarged.

Pathology:
Ascariasis of the Liver can be caused by adult worms and eggs located in the bile ducts or in the liver parenchyma, or it may also be due to Larvae remaining in the hepatic parenchyma during their life cycle. The adult parasite may die inside the Liver, giving rise to a necrotic focus.



Plan of treatment:
The diagnosis was made on 23 rd of August,2005
Patient is on Mebendazole therapy.

Discussion:
Liver abscess caused by Ascaris Lumbricoides has no distinctive clinical features to allow its differential diagnosis with Liver abscesses caused by other microorganisms. Most of the cases reported so far have been diagnosed during surgery or during autopsy.The specific diagnosis of Ascaris in Liver is established by the observation of eggs on direct or histological examination.The chronic illness and age of the patient at first appearance suggests malignancy; nevertheless an ultrasound demonstration of an abscess suggested the possibility of an associated parasitic disease which was confirmed by direct examination and cytological study. As Bangladesh is a tropical country, Parasitic Liver abscess is very common here and most of these are caused by Entamaeba Histolytica. Ascaris in Liver has not been reported so far in Bangladesh and the case is being presented here because of its rarity.














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