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S-368 A case of isolated amebic lung abscess (extraintestinal amebiasis without hepatic involvement)
( Bomi Kim ),( Byung Ju Kang ),( Seung Won Ra ),( Kwang Won Seo ),( Yangjin Jegal ),( Jae-bum Jun ),( Jiwon Jung ),( Joseph Jeong ),( Jong Joon Ahn ),( Taehoon Lee ) 대한내과학회 2016 대한내과학회 추계학술대회 Vol.2016 No.1
Amebiasis is a disease caused by the protozoa Entamoeba histolytica. Although, most amebiasis are asymptomatic, intestinal amebiasis (amebic dysentery) and extraintestinal amebiasis might arise. Extraintestinal amebiasis occurs most frequently as liver abscess by portal venous inoculation of ameba. Occasionally, amebic liver abscess could rupture into thoracic cavity, complicating lung abscess. We recently experienced a case of amebic lung abscess without hepatic involvement. Since isolated amebic lung abscess has not been reported before, we report here the case. A 75-year-old woman was transferred to our hospital with a complaint of persistent fever. 15 days ago, she visited local hospital due to 1-day fever. There were no other symptoms/signs other than fever. On initial investigations, chest radiography was normal, and pyuria was observed. She was treated with ciprofloxacin under the diagnosis of urinary tract infection. Despite 5-day ciprofloxacin, fever persisted. Follow-up chest radiography showed consolidation of left lung. On chest computed tomography (CT), sub-lobar consolidation was noted at left upper lobe. She was hospitalized, and meropenem was started. Despite 10-day intravenous meropenem, fever was continued, and the lung consolidation was gradually changed into abscess. She was transferred to our hospital for further evaluation. Bronchoalveolar lavage (BAL) was performed at the site of lung abscess. On wet smear of BAL fluid, motile macrophage-like pathogens with pseudopod were noted. By iron-hematoxylin stain, it was confirmed as E. histolytica. Any other pathogens (including mycobacteria, fungus, bacteria, or virus) were not identified. Abdomen CT, sigmoidoscopy and stool microscopy were performed to detect the evidence of intestinal/hepatic amebiasis, but there was no abnormality. Isolated amebic lung abscess was diagnosed, and metronidazole was started. After 5 days of metronidazole, defervescence was achieved. The abscess also gradually shrinked. Metronidazole was used for 4 weeks, and she was completely recovered.