He started to laugh as he uttered these words to me, but then suddenly cringed with pain. Solomon, a young man, winced and grabbed at his right side. Three days earlier Solomon developed fever, some abdominal cramping, and just a little dysentery. Such illnesses are quite common here in Angola. Solomon drake some traditional tea made by his grandmother and expected to feel better quite soon.
Instead, the next day his abdominal discomfort became quite severe. Then came profound weakness and vomiting. Solomon’s family began the 210-mile journey to our city of Lubango, where I first met him in outpatient clinic. Physical examination was rather unremarkable aside from temperature of 38.5 and right upper quadrant pain with hepatomegally. Here at CEML Hospital we keep a portable Sonosite ultrasound unit on standby. The size of a laptop computer, it’s remarkably convenient.
The above image shows Solomon’s liver containing an ill-defined, hypodense (black color) lesion. Among all those who provide healthcare in low-resources setting it’s well known that amebic liver abscess is one of the most frequent complications of Entamoeba histolytica infection. Indeed, Solomon’s stool analysis was positive for cysts of the Entamoeba histolytica organism.
What’s next in management of this man’s illness? Rather than immediately proceeding to surgical drainage we’ve opted for treatment with metronidazol and monitoring. Tomorrow he’ll undergo another assessment, including ultrasound imaging of the abscess. Hopefully next time he can chuckle and say “Something’s eating at me” without wincing in pain.