Persistent fever and right hypochondrium pain

Description

A 39-year-old patient was admitted to our hospital for 10 days fever (up to 40°C) with pain in the right hypochondrium. Abdominal echography performed at the onset of symptoms was normal. Blood tests showed C-reactive protein 311 mg/L, leucocytes count 24x10⁹ /L (neutrophils count at 19, 29x10⁹/L), bilirubin 1.1 mg/dL, lactate dehydrogenase (LDH) 254 U/L, aspartate aminotransferase (ASAT) 67 U/L, alanin aminotransferase (ALAT) 66 U/L, gammaGlutamyltransferase (gGT) 79 U/L and alkaline phosphatase 221 U/L. Chest X-ray showed an infiltrate in the right lung base. A diagnosis of pneumonia was made and treatment with cefuroxime started. Since fever and right hypochondrium pain persisted despite antibiotherapy for 5 days, abdominal CT scan was performed, which demonstrated a large hepatic mass of 10x7 cm (figure 1). Percutaneous drainage revealed a thick and brown liquid; 'chocolate-like' (figure 2). Complementary information came from anamnesis: the patient usually lives in Cambodia and he has had dysentery 3 months ago. Clinical and biological...

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