Case 2: A 25 yr old American homosexual man was seen in the ER for bloody diarrhea, crampy abd pain of several weeks duration. Was treated and symptoms resolved. 6 months later, he presented to PCP with wt loss, malaise, fever, fatigue, abd pain in the right upper quadrant. Lab studies showed leukocystosis, mild anemia, elevated liver enzymes like Alk phosphatase and transaminases. Stool was neg for bact pathogens and parasites. CT scan of liver showed several hepatic lesions. This finding was confirmed by ELISA for serum AB. The cyst of the parasite causing the infection was 10 - 20um, contained 4 nuclei plus cigar shaped structures with rounded blunt ends.
The dx is liver abscess due to Entamoeba histolytica