SHM Converge Scientific Abstract ePoster Gallery-Less Is More: Avoiding Diagnostic Overreach in a Case of Amoebic Liver Abscess With Hepatic Vein Thrombosis

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A 32-year-old woman with no major past medical history presented with one week of fever, right upper quadrant pain, and non-bloody diarrhea. She was septic on arrival, with fever, tachycardia, leukocytosis, and mild RUQ tenderness. CT and MRI showed a heterogeneous hypoattenuating lesion in the right hepatic lobe consistent with a liver abscess, along with right hepatic vein thrombosis. A GI pathogen panel was positive for <em>Entamoeba histolytica</em>, confirming amoebic liver abscess.

She was treated with oral metronidazole followed by paromomycin for intraluminal eradication. Because of the hepatic vein thrombosis, she was started on a therapeutic heparin drip and later transitioned to apixaban.

Although the thrombosis was ultimately felt to be provoked by the abscess, the unusual presentation initially raised concern for an underlying hypercoagulable disorder. Her history of long-term oral contraceptive use and a maternal history of early ischemic stroke prompted selective thrombophilia testing, including JAK2, Factor V Leiden, and DRVVT. The DRVVT returned weakly positive, but this result was later recognized as uninterpretable due to concurrent heparin use, which can cause false-positive lupus anticoagulant testing.

This case emphasizes diagnostic stewardship: in rare presentations, clinicians may be tempted to pursue broad hypercoagulable workups, but test interpretation must account for clinical context and medication effects. Hepatic vein thrombosis is a recognized complication of amoebic liver abscess, and in this setting further thrombophilia evaluation was unnecessary. Hematology recommended treatment as a provoked thrombosis for at least three months with outpatient follow-up to assess resolution.

Asset Subtitle

Tiffany Ho

Meta Tag

Author List Deepak Asudani, Tiffany Ho

Category Clinical Vignettes

Concept Amebic Liver Abscess

Concept Entamoeba histolytica

Concept Metronidazole

Concept Hepatic Vein Thrombosis

Concept Anticoagulant Use

Distinguished Non-Finalist

Presenter Organization UCSD Health

Presenting Author Tiffany Ho

Track Adult

Keywords

amoebic liver abscess

Entamoeba histolytica

hepatic vein thrombosis

right upper quadrant pain

sepsis

metronidazole

paromomycin

heparin

apixaban

thrombophilia testing

Amebic Liver Abscess

Entamoeba histolytica

Metronidazole

Hepatic Vein Thrombosis

Anticoagulant Use