Teenager has cough and right upper quadrant pain (2023)

A previously healthy 17-year-old male presents to your office with a fever, cough, and right upper quadrant pain with recurrent nausea, vomiting, and diarrhea.

History of this disease showed a gradual onset of symptoms that began about 2 weeks earlier. Her medical history is positive as she was born and raised in central Mexico before moving to the southern United States at the age of 13. However, she recently returned to her hometown in Mexico to visit relatives, where she spent two weeks before returning to the United States two months ago.

Examination revealed a fever of 102.7 °F, slight weight loss, and right upper quadrant (RUQ) tenderness on palpation. Laboratory results available include a normal blood count, a slight elevation in liver enzymes, a C-reactive protein (CRP) level of 214, and a negative result.equinoxAntibody test previously filed with the CDC based on the image shown here. A fecal pathogen panel is pending and a CT scan of the abdomen shows a large cystic liver lesion (Figures 1-3).

Summary:

• The patient is a previously healthy 17-year-old male.
• He spent much of his time in central Mexico.
• Symptoms include fever, cough, and pain in the upper right abdomen, as well as intermittent nausea, vomiting, and diarrhea.
• The laboratory values ​​were normal except for a PCR of 214 and the patient has a negative test.equinoxantibody test
• The image shows a large cystic lesion in the liver.

What's your diagnosis?

A. Toxocariasis
B. Amöbiasis
C. Pure hydatid disease
D. Pyogenic liver abscess

The answer is Bamebiasis. This is a very typical history of extraintestinal amebiasis with very favorable laboratory and imaging results. This process begins with the ingestion of mature cysts, which transform into trophozoites in the small intestine and migrate to the large intestine, as shown in Fig.this figure of the life cycle of CDC. There, the trophozoites can remain in asymptomatic carriers, cause colitis, or penetrate the mucosa and spread, usually to the liver. The diagnosis can be suspected with a positive stool PCR panel forEntamoeba histolyticathat this patient had. However, the false positive rate is so high that a confirmatory microscopic examination may be necessary. This patient also had a positive antibody test forE. histolytic. Treatment of a large amebic liver abscess is best managed by needle aspiration using interventional radiology (Figure 4) combined with drug therapy using a combination of metronidazole for 10 days, followed by an intraluminal amebicide such as paromomycin for 7 days and follow-up. Documentation of clearance by repeated stool analysis. This case showed no signs of disease at 1 year follow-up (Figure 5).

Before suctioning off the abscess, it is advisable to rule out echinococcosis with a hydatid cyst. In this case, the lesion on CT appeared to be a single cystic lesion rather than the multicystic lesion characteristic of a hydatid cyst. In addition, the patient had a negative test.equinoxCDC antibody test, which is the likelihood of having echinococcosis with a single cyst and a negative resultequinoxAntibody test along with positive stool and antibody test for amebiasis appears too low.

A case of visceral larva migrans (toxocariasis) can be reviewed inColumn From 2020. The liver lesions are small and hypoechoic as seen in Figure 6, not cystic. Finally, a pyogenic liver abscess can look similar but is very rare in otherwise healthy children. Also, I would expect the child to get sicker with so much pus collecting.

Columnist's Comments

You may have noticed that I've been pretty quiet about the COVID-19 pandemic so far. That is It's not that I'm not interested, just a little exhausted. We are inundated with information on this subject and can hardly turn a page in a newspaper or TV station without hearing the latest news over and over again. That is It's hard not to get a little arrogant after all this time. Also, I prefer to present in this column cases and problems that pose a little more diagnostic challenge, like this one. NO Don't get me wrong, this pandemic is probably considered the most important event in the career of any infectious disease specialist, but only because of its scale, not the diagnostic challenge. Infectious disease specialists are inherently diagnosticians: physicians Detectives, and are often asked to explain a confusing clinical picture. That is the thrill of a clinical discovery or diagnosis that drives many of us; certainly not the money. In my experience, a significant part of the consultations are carried out by patients without infectious diseases. Sometimes those are the most rewarding.

One of my greatest clinical moments was when I diagnosed Addison's disease (that's right, Addison, not Addison) in a 17-year-old man who was referred to me for chronic fatigue and being unwell for over a month. In Texas, many people have dark skin, but there was something unusual about their skin tone. I asked him to take off his shirt and raise his arms; He was "fully tanned" with no "tanning history". After some quick blood tests, which showed low sodium and high potassium, and a on the same day Consultation in the endocrinology clinic, the mystery of a month was solved. My only regret is that I didn't take any photos of it.

It reminds me that as I get older and see fewer patients, my clinical options (cases and photos) get smaller and smaller. If anyone has a publication quality photo with permission to use it and would like to become a guest columnist, please let me know and I will help make it happen. Now back to COVID-19!

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Brian is a member ofinfectious diseases in childrenmiInfectious disease newsEditorial Boards and Associate Professor of Pediatric Infectious Diseases at McLane Children's Hospital, Baylor Scott & White Health, Temple, Texas. can be reachedjhbrien@aol.com.