Case Report

Dyspnea and Dysentery: A Case Report of Pleuropulmonary Amebiasis

Authors: Merica Shrestha, MD, Anita Shah, DO, Christopher Lettieri, MD

Abstract

Pleuropulmonary amebiasis is an uncommon complication of Entamoeba histolytica infection. It typically occurs in endemic regions including Central and South America, Africa and the Indian subcontinent. The case of a previously healthy US Army male stationed in Liberia with an acute onset of fevers, abdominal pain and bloody diarrhea is presented. He developed a productive cough with pleuritic chest pain and imaging revealed multiple liver abscesses, with rupture through the diaphragm causing a large right pleural empyema. A positive Entamoeba histolytica serum antibody and pleural fluid antigen confirmed the diagnosis. Surgical drainage of the pleural empyema and medical treatment with antiparasitics were necessary for symptom and disease resolution.


Key Points


* Amebiasis should be considered in patients from endemic areas presenting with fevers, abdominal pain and bloody diarrhea. Pleuropulmonary disease may manifest as productive cough, dyspnea and chest pain.


* The nonspecific clinical findings and difficulty isolating Entamoeba histolytica make the diagnosis problematic. Antigen-specific testing and a strong clinical suspicion are the best tools to identify infected individuals.


* Aspiration and drainage of pleural empyemas not only assist in diagnostic evaluation, but are essential to clinical improvement.


* The suspicion of amebic infection warrants empiric medical therapy in order to prevent invasive disease, and a full course of therapy is necessary for resolution.

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