CASE 289: GRAPE'S SIGN in LIVER, Dr PHAN THANH HẢI, MEDIC MEDICAL CENTER, HCMC, VIETNAM

Man 27yo, one  month  ago, suffered from pain at  liver  with  low grade  fever.

First visiting of MEDIC ultrasound, he was detected at  segment 7 of liver  multiple  spots,  hypoechoic, size of 1-2 cm  with  the round border,  no rising vessels on Doppler. Elastoscan of these lesions was soft  tissue  as abscess. 

 Blood tests presented  WBC rising and parasite tests were  normal.

One  week later, with  more pain at liver, CT scan with CE made image  like  grapefruit as an abscess.

Blood tests:  WBC rising  and  more eosinophil, CRP and IgE rising.

Discussion:

Based on clinical  signs  and  blood tests rising eosinophil ( 1.05 /n, <0.5 x10-9 ), CRP =  62.23 , IgE=670) and liver US  and  CT scanning with  multiple abscesses  like  grapefruit, we suggested parasite  abscesses  of liver, but  ELISA test not positive with any common parasite.

TREATMENT  IS  FOCUS  ANTI PARASITE LIVER ABSCESS.

After  2 days of ANTIPARASITE TREATMENT patient had  cough  and  pain at  right chest.

Chest Xrays  detected infiltration  lesion at  upper  pole  of right lung.

CT of lung  with  CE suspected  tuberculosis  with pleural effusion..

Puncture  aspiration of the pleural fluid that was clear yellow color.

Pleural fluid analysis : ADA was low value, NOT CORELATED WITH  TUBERCULOSIS.

Wait for  PCR result later.