In the past it was stressed that amoebic liver abscess is usually single. With modern imaging available, it is coming to light that multiple amoebic liver abscesses arc very common. The following case report highlights this finding .

Case Report

A 32 year old male patient presented with symptoms of fever and a dull ache in the right hypochondrium of 5 days duration. There was a past history of dysentery six months back. The patient was a social drinker. On examination the presence of a tender hepatomegaly suggested a diagnosis of "Amoebic Hepatitis''.

The patient was then referred to me. I suspected an amoebic absecss of the liver. Both Isotope Liver Scan and sonography of the liver were normal. The l.H.A. test was .strongly positive at a titre of 1:2560. I therefore requested a CT scan.

Fig. shows the appearance shown in the CT scan. Three small hypodense areas were seen in the liver. This appearance was consistent with a diagnosis of multiple liver abcesses. The l.H.A test favoured the ahscesses as being caused by E. histolytica. Routine blood count and stool examination were normal.

The patient was put on a combination of inj. dihydro-emetine 60 mg IM daily and metronidazole in a dose of 600 rng. three times a dav. The symptoms of the patient disappeared completely within a short span of five days. The tender hepatomegaly also regressed completely. CT Scan repeated after two months showed a normal appearance.

Discussion

I have often stressed during the last few years, that the entity of amoebic hepatitis does not exist. [1] It was because of the lack of modern imaging techniques that this nomenclature was being used. Now that CT scans are available, an accurate diagnosis is possible. This is even if both isotope liver scan and sonography are normal in a patient having symptomatic tender hepatomegalv. A CT scan should clinch the diagnosis, while a positive I.H.A. test would confirm its amoebic etiology. If the patient cannot afford expensive investigations, antiamoebic drugs can be started and the patient should be labelled as a case of ''hepatic amebiasis". Such a patient could have only a single small abscess or multiple small abscesses. Amoebic aetiology proved only by serological tests for amoebiasis

REFERENCES

1. Kapoor O.P., Amoebic Hepatitis : Non entity Proved by Imaging, Bulletin of Jaslok Hospital and Research Centre, 1984. 9:2:36