一位男性以腹痛黃疸為表現

Abstract

腹痛和黃疸於臨床常被臆斷為膽道疾病。本個案因腹痛、黃疸為表現，初期以膽道感染治療， 但因腹痛加劇、血壓下降，緊急安排腹部電腦斷層，發現左葉肝膿瘍已破裂，經皮穿肝引流治療，膿液培養出克雷白氏肺炎桿菌感染，經抽血檢測阿米巴血液凝集試驗發現阿米巴感染，投以標準用藥後病情獲得控制，預後良好。此個案免疫功能正常，但同時罹患阿米巴肝膿瘍合併細菌性肝膿瘍的感染，且發生在肝臟左葉，是極為少見的案例。臨床上個案若以腹痛、黃疸表現，但為免疫功能正常，從事高風險職業、接觸土壤或水源汙染者，應將阿米巴肝膿瘍列入鑑別診斷， 儘快釐清病因，迅速診斷，以免延誤治療先機。

 

Abdominal pain and jaundice are often clinically presumed to be symptoms of biliary tract dis­ease. This case who suffered from abdominal pain and jaundice was initially treated as biliary tract infection. However, due to the exacerbation of abdominal pain and the drop in blood pressure, the computed tomography was urgently arranged, and a rupture of abscess on left lobe was found. Per­cutaneous transhepatic drainage of abscess was performed and Klebsiella pneumoniae was cultured. Furthermore, the Amoebic hemagglutination test was positive from the blood. After standard drug treatment, the condition was controlled with good prognosis. However, in immunocompetent patients, the simultaneous occurrence of amebic and bacterial liver abscesses in the left lobe of the liver is very rare. Clinically, an immunocompetent patient presents with abdominal pain and jaundice, and those who have high-risk occupations and are exposed to soil or water pollution, amebic liver abscess should be included in the differential diagnosis. Identifying the causes as soon as possible could lead to early diagnose and to avoid the delays in treatment.