Schistosomiasis: predisposing cause for the formation of hepatic abscesses? Case report

Lima, Vasco Carvalho Pedroso de; Maluf, Fernando Cotait

doi:10.1590/S0036-46651995000300017

Abstracts

An adult patient with chronic schistosomiasis from an endemic area, complained about a seven day fever, along with jaundice and lumbar backache on the right side. Image exams showed multiple pyogenic liver abscesses. All the classic etiologies were discarded through clinical, radiological and laboratorial criteria. Schistosomiasis can cause pylephlebitis as a complication, along with immunesuppression, granulomatous reaction with central lobular liver necrosis and a greater risk of infection. The authors suggest that schistosomiasis in its chronic form may be the predisposing cause of multiple pyogenic liver abscesses, especially in endemic areas.

Schistosomiasis; Hepatic abscess; Liver abscess

Paciente adulto, natural de região endêmica para esquistossomose e portador crônico da doença, apresentava queixa de febre há sete dias, associada à ictericia e dor lombar em região direita. Os exames radiológicos mostraram abscessos hepáticos piogênicos múltiplos, cuja causa predisponente é conhecida, segundo trabalhos da literatura, em 100% dos casos. Através de parâmetros clínicos, laboratoriais e radiológicos todas as etiologias clássicas foram afastadas. Sabe-se que a esquistossomose pode provocar, como complicação, a pileflebite, além de depressão imunológica e reação granulomatosa com necrose lobular central e maior risco de infecção. Os autores deste relato de caso sugerem ser a esquistossomose, na sua forma crônica, causa predisponente para formação de abscessos hepáticos piogênicos múltiplos, principalmente em regiões endêmicas.

CASE REPORT

Schistosomiasis: predisposing cause for the formation of hepatic abscesses? Case report

Esquistossomose: causa predisponente para a formação de abscessos hepáticos?

Vasco Carvalho Pedroso de Lima^I; Fernando Cotait Maluf^II

^IPhysician, Infectious Disease Unit, Hospital Emílio Ribas, SP, Brasil

Clinical Professor of Medicine, Division of Infectious Diseases, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil

^IIIntern in Infectious Diseases, Faculdade de Ciências Médicas da Santa Casa de São Paulo, Brasil

^{Correspondence to} Correspondence to: Hospital Emílio Ribas, Diretoria de Apoio Técnico Av. Dr. Arnaldo, 165 01246-000, São Paulo, SP, Brasil

SUMMARY

An adult patient with chronic schistosomiasis from an endemic area, complained about a seven day fever, along with jaundice and lumbar backache on the right side. Image exams showed multiple pyogenic liver abscesses. All the classic etiologies were discarded through clinical, radiological and laboratorial criteria. Schistosomiasis can cause pylephlebitis as a complication, along with immunesuppression, granulomatous reaction with central lobular liver necrosis and a greater risk of infection. The authors suggest that schistosomiasis in its chronic form may be the predisposing cause of multiple pyogenic liver abscesses, especially in endemic areas.

Keywords: Schistosomiasis; Hepatic abscess; Liver abscess.

RESUMO

Paciente adulto, natural de região endêmica para esquistossomose e portador crônico da doença, apresentava queixa de febre há sete dias, associada à ictericia e dor lombar em região direita. Os exames radiológicos mostraram abscessos hepáticos piogênicos múltiplos, cuja causa predisponente é conhecida, segundo trabalhos da literatura, em 100% dos casos. Através de parâmetros clínicos, laboratoriais e radiológicos todas as etiologias clássicas foram afastadas. Sabe-se que a esquistossomose pode provocar, como complicação, a pileflebite, além de depressão imunológica e reação granulomatosa com necrose lobular central e maior risco de infecção. Os autores deste relato de caso sugerem ser a esquistossomose, na sua forma crônica, causa predisponente para formação de abscessos hepáticos piogênicos múltiplos, principalmente em regiões endêmicas.

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

Recebido para publicação em 17/08/1994.

Aceito para publicação em 02/06/1995.

1. COLLEY, D.G.; HIENY, S.E.; BARTHOLOMEW, R.K. & COOK, J.A. - Immune responses during human schistosomiasis mansoni. III. Regulatory effect of patient sera on human lymphocyte blastogenic responses to schistosome antigen preparations. Amer. J. trop. Med. Hyg., 26: 917-925, 1977.
2. GARTY, B. -Z.; CONLEY, M.E.; DOUGLAS, S.D. & KOLSKI, G.B. - Recurrent infections and staphylococcal liver abscess in a child with Clr deficiency. J. Allergy clin. Immunol., 80: 631-635, 1987.
3. HIATT, R.A.; SOTOMAYOR, Z.R.; SANCHEZ, G.; ZOMBRANA, M. & KNIGHT, W.B. - Factors in pathogenesis of acute schistosomiasis mansoni. J. infect. Dis., 139: 659-666, 1979.
4. HOFSTETTER, M.; POINDEXTER, R.W.; RUIZ-TIBEN, E. & OTTESEN, E.A. - Modulation of the host response in human schistosomiasis. III. Blocking antibodies specifically inhibit immediate hypersensitivity responses to parasite antigens. Immunology, 46: 777-785, 1982.
5. LAMBERTUCCI, J.R.; TEIXEIRA, R.; NAVARRO, M.M.M.; COELHO, P.M.Z. & FERREIRA, M.D. - Liver abscess and schistosomiasis. A new association. Rev. Soc. bras. Med. trop., 23: 239-240, 1990.
6. McDONALD, A.P. & HOWARD, R.J. - Pyogenic liver abscess. Wld. J. Surg., 4: 369-376, 1980.
7. MCDONALD, M.I.; COREY, G.R.; GALLIS, H.A. & DURACK, D.T. - Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore), 63: 291-302, 1984.
8. OCHSNER, A.; DEBAKEY, M. & MURRAY, S. - Pyogenic abscesses of the liver. II. An analysis of forty-seven cases with review of the literature. Amer. J. Surg., 40: 292-319, 1938.
9. OTTESEN, E.A.; POINDEXTER, R.W. & HUSSAIN, R. - Detection, quantitation and specificity of antiparasite IgE antibodies in human schistosomiasis mansoni. Amer. J. trop. Med. Hyg., 30: 1228-1337, 1981.
10. OTTESEN, E.A. & POINDEXTER, R.W. - Modulation of the host response in human schistosomiasis. II. Humoral factors with inhibit lymphocyte proliferative responses to parasite antigens. Amer. J. trop. Med. Hyg., 29: 592-597, 1980.
11. PITT, H.A. & ZUIDEMA, G.D. - Factors influencing mortality in the treatment of pyogenic abscesses. Surg. Gynec. Obstet., 140: 228-234, 1975.
12. RAMBO, W.M. & BLACK, H.C. - Intrahepatic abscess. Amer. Surg., 35: 144-148, 1969.
13. ROCKLIN, R.E.; BROWN, A.P.; WARREN, K.S. et al. - Factors that modify the cellular-immune response in patients infected by Schistosoma mansoni. J. Immunol., 125: 1916-1923, 1980.
14. RUBIN, R.H.; SWARTZ, M.N. & MALT, R. - Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Amer. J. Med., 57: 601-610, 1974.
15. TODD, C.W.; GOODGAME, R.W. & COLLEY, D.G. - Immune responses during human schistosomiasis mansoni. V. Supression of schistosome antigen-specific lymphocyte blastogenesis by adherent/phagocytic cells. J. Immunol., 122: 1440-1446, 1979.
16. WALLER, 1846 apud LOISSON, E. - Des suppurations intra et perihépatiques d'origine typhlo-appendiculare. Rev. Chir. (Paris), 21: 522, 1900

Correspondence to:

Hospital Emílio Ribas, Diretoria de Apoio Técnico

Av. Dr. Arnaldo, 165

01246-000, São Paulo, SP, Brasil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
June 1995

History

Received
17 Aug 1994
Accepted
02 June 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. COLLEY, D.G.; HIENY, S.E.; BARTHOLOMEW, R.K. & COOK, J.A. - Immune responses during human schistosomiasis mansoni. III. Regulatory effect of patient sera on human lymphocyte blastogenic responses to schistosome antigen preparations. Amer. J. trop. Med. Hyg., 26: 917-925, 1977.

[2] 2. GARTY, B. -Z.; CONLEY, M.E.; DOUGLAS, S.D. & KOLSKI, G.B. - Recurrent infections and staphylococcal liver abscess in a child with Clr deficiency. J. Allergy clin. Immunol., 80: 631-635, 1987.

[3] 3. HIATT, R.A.; SOTOMAYOR, Z.R.; SANCHEZ, G.; ZOMBRANA, M. & KNIGHT, W.B. - Factors in pathogenesis of acute schistosomiasis mansoni. J. infect. Dis., 139: 659-666, 1979.

[4] 4. HOFSTETTER, M.; POINDEXTER, R.W.; RUIZ-TIBEN, E. & OTTESEN, E.A. - Modulation of the host response in human schistosomiasis. III. Blocking antibodies specifically inhibit immediate hypersensitivity responses to parasite antigens. Immunology, 46: 777-785, 1982.

[5] 5. LAMBERTUCCI, J.R.; TEIXEIRA, R.; NAVARRO, M.M.M.; COELHO, P.M.Z. & FERREIRA, M.D. - Liver abscess and schistosomiasis. A new association. Rev. Soc. bras. Med. trop., 23: 239-240, 1990.

[6] 6. McDONALD, A.P. & HOWARD, R.J. - Pyogenic liver abscess. Wld. J. Surg., 4: 369-376, 1980.

[7] 7. MCDONALD, M.I.; COREY, G.R.; GALLIS, H.A. & DURACK, D.T. - Single and multiple pyogenic liver abscesses. Natural history, diagnosis and treatment, with emphasis on percutaneous drainage. Medicine (Baltimore), 63: 291-302, 1984.

[8] 8. OCHSNER, A.; DEBAKEY, M. & MURRAY, S. - Pyogenic abscesses of the liver. II. An analysis of forty-seven cases with review of the literature. Amer. J. Surg., 40: 292-319, 1938.

[9] 9. OTTESEN, E.A.; POINDEXTER, R.W. & HUSSAIN, R. - Detection, quantitation and specificity of antiparasite IgE antibodies in human schistosomiasis mansoni. Amer. J. trop. Med. Hyg., 30: 1228-1337, 1981.

[10] 10. OTTESEN, E.A. & POINDEXTER, R.W. - Modulation of the host response in human schistosomiasis. II. Humoral factors with inhibit lymphocyte proliferative responses to parasite antigens. Amer. J. trop. Med. Hyg., 29: 592-597, 1980.

[11] 11. PITT, H.A. & ZUIDEMA, G.D. - Factors influencing mortality in the treatment of pyogenic abscesses. Surg. Gynec. Obstet., 140: 228-234, 1975.

[12] 12. RAMBO, W.M. & BLACK, H.C. - Intrahepatic abscess. Amer. Surg., 35: 144-148, 1969.

[13] 13. ROCKLIN, R.E.; BROWN, A.P.; WARREN, K.S. et al. - Factors that modify the cellular-immune response in patients infected by Schistosoma mansoni. J. Immunol., 125: 1916-1923, 1980.

[14] 14. RUBIN, R.H.; SWARTZ, M.N. & MALT, R. - Hepatic abscess: changes in clinical, bacteriologic and therapeutic aspects. Amer. J. Med., 57: 601-610, 1974.

[15] 15. TODD, C.W.; GOODGAME, R.W. & COLLEY, D.G. - Immune responses during human schistosomiasis mansoni. V. Supression of schistosome antigen-specific lymphocyte blastogenesis by adherent/phagocytic cells. J. Immunol., 122: 1440-1446, 1979.

[16] 16. WALLER, 1846 apud LOISSON, E. - Des suppurations intra et perihépatiques d'origine typhlo-appendiculare. Rev. Chir. (Paris), 21: 522, 1900