I describe below four cases of the liver disease labeled elsewhere as Amoebic Hepatitis, all of whom I investigated with CT imaging procedures. Three of them showed multiple small amoebic abscesses and one showed a single amoebic liver abscess. All of these patients recovered with the help of only antiamoebic drugs, without hepatic aspiration.

This confirms my initial impression that the entity of amoebic hepatitis is non-existent and this terminology should be removed from the textbooks.

Material and Method

During the last two years, on four occasions patients were referred to me in my clinic labeled as amoebic hepatitis. All these patients complained of fever and pain in the right hypochondrium had a tender hepatomegaly. However, there was no point tenderness or intercostal tenderness to suggest an amoebic abscess. The right dome of the diaphragm was normal in all the four cases. I.H.A. test for amoebiasis was positive in more than 1: 256 in all the cases.

Since in private practice, cost of investigation is a problem I was not expecting to find a large abscess in any of these patients an abscess of less than 2 cm may not be seen on isotope liver scan CT imaging of a very small abscess would be superior to sonography, I decided to ask for CT Scan in all these four cases. Three of them showed multiple small abscesses in both the lobes (Fig. 1) and in one case a large abscess was seen in the right lobe.All the four patients responded to medical line of treatment without liver aspiration.

Discussion

In 1965, I reported from J. J. Hospital, Bombay that based on the clinical records of 292 patients discharged with a label of final diagnosis of hepatic amoebiasis, only 66 had an abscess. The rest of the 266 cases suffered from Amoebic Hepatitis. At that time no liver imaging was available. Only hepatic tapping and the type of pus helped to diagnose amoebic liver abscess. No serological tests were available to confirm the 'amoebic' etiology of the rest of the cases of hepatitis.

Thirteen years later in 1979, based on my autopsy experience and experience with early hepatic imaging and serological tests of amoebiasis, I wrote that the above entity does not exist. [2]

In Bombay at that time we had the availability of only Isotope liver scanning and laparoscopy to image the liver. Since then we had the increasing availability of ultrasonography of the liver. Recently for the last 2 to 3 years CT Scanning of the liver has been available in Jaslok Hospital and at other places in Bombay.

In the above four cases of so called "Amoebic Hepatitis", at least in three cases the isotope liver scan would have missed the diagnosis of "multiple" small liver abscesses and since the patients would respond to only medical treatment without liver aspiration, they would have been labeled as amoebic hepatitis in presence of a strongly positive l.H.A. test or amoebiasis.

From the above study, it can also be concluded that in future, if any practitioner comes across a case of fever, pain in the right hypochondrium and a tender hepatomegaly, without severe pain or point tenderness, if I.H.A. test (or any other serological test for ameobiasis) is positive, the patient can be given anti-amoebic drugs and would certainly respond. The important point is, if I.H.A. is not done (because of non-availability and high cost), then response to antiamoebic drugs would not mean anything, because such a patient could be having any other type of hepatitis (like alcoholic) or even a Gall Bladder disease where the 'so called' liver tenderness is 'non hepatic' and due to inflamed gall bladder.

Summary

Four cases diagnosed as Amoebic Hepatitis and having a strong positive I.H.A. test were subjected to CT Scan study. Three of the four showed multiple small liver abscesses and one case showed a single abscess. They all responded to medical treatment. The conclusion that the entity of 'amoebic hepatitis' is non existent, has been now proved by modern imaging.

Acknowledgement

I am grateful to Dr. N. H. Keswani, Medical Director, Jaslok Hospital & Research Centre, Bombay for allowing me to publish this material.

References

1. KAPOOR 0. P., TULPULE T. H. and SAINANI G. S., Hepatic Amoebiasis, J.A.P.I. 13, 767, 1965.
2. KAPOOR 0. P. Amoebic Liver Abscess, Preface, 1979.