AMEBIC LIVER-ABSCESS COMPLICATED WITH CARDIAC-TAMPONADE AND MEDIASTINAL ABSCESS

Amebic pericarditis is an extremely rare complication of liver abscess and an uncommon etiology of sterile pericardial effusion with cardiac tamponade. The association of mediastinal abscess in this clinical se tting has not been reported in the literature. Herein, we describe a c ase of amebic liver abscess complicated with mediastinal abscess and a mebic pericarditis with cardiac tamponade. A 44-year-old man was admit ted to our hospital because of shortness of breath for the previous 2 days. Cardiac tamponade was diagnosed and emergency pericardiectomy wa s performed. Chocolate-like pus was found in the pericardial sac and m ediastinal space during surgery. Abdominal computed tomography reveale d an ill-defined hypodense lesion over the left lobe of the liver, sug gesting a liver abscess. Amebic liver abscess and pericarditis were di agnosed on the basis of a high serum titer of amebic antibodies on hem agglutination test. The patient was treated with metronidazole for 2 w eeks and discharged in good condition. This case should alert clinicia ns to the possibility of amebic pericarditis in patients with cardiac tamponade associated with chocolate-like sterile pus in the pericardiu m and mediastinum. To establish the diagnosis of amebic pericarditis, one should investigate the presence of a liver abscess, a high serum t iter of amebic hemagglutination antibodies, and the presence of Entamo eba histolytica trophozoites in the pericardium or pericardial aspirat e.