A man aged 67, with a background of high cholesterol and gout, arrived at the hospital after experiencing daily fevers and shaking chills for nearly a month. The worst episodes struck between late evening and early morning, pushing his body temperature to 105°F. Each fever spike lasted up to an hour, accompanied by severe chills that left him drenched in sweat afterward. He also noticed swelling in both legs, a loss of appetite, and urine that had taken on an orange hue.
During a prior hospital stay just seven days before this visit, doctors had run extensive tests—including heart ultrasound, bone marrow biopsy, and infectious disease screening—but found nothing conclusive. Before that admission, he had been prescribed antibiotics for what was thought to be a respiratory infection, though these provided no relief.
Five months earlier, the patient had traveled to Peru, where he swam in the Amazon River. He had also visited Japan earlier in the year, though no symptoms emerged until his return. His current medications included tirzepatide, allopurinol, and aspirin.
Medical Background and Examination
The patient’s medical records showed long-standing issues with hyperlipidemia, gout, and obesity. Upon arrival at the emergency room, his temperature stood at 100.6°F, with a slightly raised heart rate and rapid breathing. Despite these signs, he appeared alert and comfortable, though physical checks revealed dry mouth tissues and severe swelling in both legs.
Heart and lung examinations showed normal rhythms and clear breathing sounds. His abdomen was soft, without tenderness or signs of liver disease.
Diagnosis and Management
Initial bloodwork uncovered raised white blood cells, anemia, low platelet counts, reduced protein levels, and high inflammation markers. A CT scan of his abdomen revealed a clot in the portal vein, a small growth on the right side of his liver, an enlarged spleen, and a small amount of fluid in his belly.
Doctors began treating him with heparin to prevent clots and took blood samples, which later confirmed a mixed bacterial infection. He was first given broad-spectrum antibiotics, meropenem, before switching to ceftriaxone and metronidazole based on specialist advice.
Further testing confirmed antibodies for Entamoeba histolytica, leading to a diagnosis of invasive amoebiasis with a liver abscess. His fevers disappeared, white blood cell counts returned to normal, and follow-up blood tests showed no remaining infection.
A more detailed heart ultrasound later detected a small, mobile mass on his mitral valve, suggesting possible infective endocarditis. The patient was sent home in stable condition with a catheter for continued antibiotic treatment and a follow-up appointment, while switching to apixaban to manage his portal vein clot.
Given his recent travel and exposure to contaminated water, doctors suspected a parasitic infection. After ruling out other causes, they adjusted his treatment to target E. histolytica while continuing antibiotics for the bacterial components.
Follow-Up and Recovery
The patient was released with instructions to continue intravenous antibiotics at home and attend an infectious disease clinic one week later. His blood clotting medication was switched to apixaban. He was discharged in stable condition with a peripherally inserted central catheter for outpatient intravenous antibiotic therapy and infectious disease follow-up one week after discharge.
His positive test for E. histolytica, combined with his travel to Peru and swimming in the Amazon, confirmed an amoebic liver abscess.