A 30 year-old married woman, suffered from weight loss, fatigue,
not fever, not abdominal pain. She has scanned by abdominal ultrasound at a province
hospital detecting multifocal lesions in liver. Her doctor thought her liver
hemangioma.
At MEDIC center, ultrasound scanning detected
multi-hyperechoic masses with regular border, no vascular proliferative, no around
liver parenchyma edema, no necrosis fluid, size of 0.5 to 2cm in right and left
lobe.
CT Scan of liver was done with many reduced density
lesions in the right and left lobe. The lesions were slight contrast
enhancement. Some lesions were higher than in the center area.
Blood test with WBC normal, transaminases slight
increase, HBsAg negative, anti-HCV negative. The important noticeable
result is that anti-HIV positive (ELISA).
The findings of ultrasound, CT Scan and
blood test suggested liver fungal infection in HIV-infected patient. This
patient was treated with anti-fungal drugs. Fungal infection is a common
opportunistic disease in HIV-infected patient. Among the fungal opportunistic
infections, Coccidioides immitis and Histoplasma capsulatum are those most likely
to involve the liver [1]. Fungal liver abscess diagnosis remains
a challenge for diagnostic
imaging and clinical.
What is your suggestion of diagnosis?
References:
1. Anthony S. Fauci; H.
Clifford Lane (2010). “Human immunodeficiency virus disease: AIDS and related
disorders”. Harrison’s infectious
diseases. Mc Graw Hill. p. 847
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