[Amoebic Liver Abscess][Dr. O.P. Kapoor]
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ATYPICAL PRESENTATION

. To every clinician, an atypical presentation carries a different definition, depending on his awareness and knowledge of the amoebic liver abscess. Thus, patients of amoebic liver abscess with minimal symptoms and signs or else presenting primarily with a complication, have been included by some in the above definition. Vakil et al1 have included patients of amoebic liver abscess presenting with acute abdomen as atypical presentation. Many authors include amoebic pericarditis as an atypical presentation. Similarly patients presenting with a P.U.O. or a silent abscess have been placed by some in this category.
Others have included jaundice as an 'atypical' manifestation.' This is because in the past it was thought that jaundice cannot occur in patients having amoebic liver abscess. Today we know that as many as 28% cases may have clinical or subclinical icterus. This sign can no more be regarded as atypical.
However, patients of an amoebic liver abscess presenting with deep obstructive jaundice, should definitely be considered as atypical. This has been further discussed in Section 111.

Following are some of the interesting case reports of atypical presentations:
One of the patients seen by Rab et al2 was brought in a state of collapse and stupor with a history of pain in the right hypochondrium and fever since six weeks. He went into coma and died. At autopsy an amoebic liver abscess was seen which had destroyed his right suprarenal gland.
Vakil et al' have described patients admitted with hepatic coma and having jaundice, spider naevi and palmar erythema. In some of them, a lump was palpable in the hepatic area ands ascites was present. Similarly Saltzman et al3 have reported a patient presenting with deep jaundice and hepatorenal syndrome. Out of 11 patients of hepatic coma due to amoebic liver abscess reported by Mehta et al,4 3 were diagnosed at autopsy, 4 were admitted in coma but the abscess was diagnosed before death and 4 patients developed coma in the wards. Though hepatic coma is fatal in most patients and the diagnosis is made at autopsy, recovery from it and a cure of the abscess has been reported.2

References

  1. Vakil, B J. Mehta, A J, et al, J. Trop. Med. Hyg,1970, 73, 63.
  2. Rab, S M, and Alam, N. Am. J. Med. 1967, 43, 811.
  3. Saltzman, D A, Smithline, N C, et al, Am. J. Dig Dis., 1978, 23, 561.
  4. Mehta, A J, and Vakil, B J. Ind. J. Med. Sci., 1970, 24, 478.