SHM Converge Scientific Abstract ePoster Gallery-Ameba in the Liver, Platelets in the Sky: An Unusual Diagnostic Journey

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A 24-year-old man with no significant past medical history presented with 4 days of right upper quadrant abdominal pain worsened by oral intake, fever, and tenderness radiating to the lumbar region. He had recently arrived from Liberia, Africa, one month earlier. On exam, he was tachycardic with severe right upper quadrant guarding but no jaundice. Labs showed mild transaminitis and cholestatic enzyme elevation, leukocytosis with neutrophilia, anemia, and marked thrombocytosis that peaked at 1,239,000/µL. Hepatitis C antibody was positive, but HCV RNA was undetectable. Blood cultures, HIV testing, and malaria evaluation were negative.<br /><br />Imaging revealed a multiloculated, multifocal confluent hepatic abscess, with the largest lesion measuring 7.4 cm in the right hepatic lobe. During hospitalization, Entamoeba histolytica IgG returned positive, confirming amebic liver abscess (ALA). Because the extreme thrombocytosis raised concern for a myeloproliferative disorder, JAK2 V617F and exon 12–13 testing were performed and were negative, supporting a reactive process rather than a primary marrow disease.<br /><br />The case highlights that ALA can present not only with fever and right upper quadrant pain, but also with striking reactive thrombocytosis. This is thought to result from inflammation-driven cytokine release, including IL-6 and thrombopoietin, as well as hepatic necrosis. After abscess drainage and antibiotic therapy, the patient’s platelet count gradually normalized alongside clinical improvement.<br /><br />This case emphasizes the importance of interpreting laboratory abnormalities in clinical context to avoid unnecessary hematologic workup or anticoagulation.

Asset Subtitle

Tulsi Bhatt

Meta Tag

Author List Bhavika Agrawal, Sai Abhishek Narra, Tulsi Bhatt

Category Clinical Vignettes

Concept Amebic Liver Abscess

Concept Reactive Thrombocytosis

Concept Right Upper Quadrant Pain

Concept Extreme Thrombocytosis

Concept Fever

Distinguished Non-Finalist

Presenter Organization Mercy Catholic Medical Center

Presenting Author Tulsi Bhatt

Track Adult

Keywords

amebic liver abscess

Entamoeba histolytica

right upper quadrant pain

reactive thrombocytosis

hepatic abscess

fever

cholestatic enzymes

JAK2 negative

Liberia travel history

inflammatory cytokines

Amebic Liver Abscess

Reactive Thrombocytosis

Right Upper Quadrant Pain

Extreme Thrombocytosis

Fever