Acute Pancreatitis Associated with Amoebic Liver Abscess

We present a rare case of acute pancreatitis in a 50-year-old man with amoebic liver abscess. He had a right lobe liver abscess along with markedly elevated serum lipase and amylase levels and edematous pancreas. Liver abscess was aspirated. The patient was managed conservatively with antibiotics and improved without any complications. Acute pancreatitis associated with ALA is not reported in the literature till date. 1. Case Report A 50-year-old male, nonalcoholic, presented with pain in right upper abdomen for the last 7 days which had increased in severity in the last 24 hours. He had not passed flatus for the last 12 hours. The patient had a history of acute diarrhea 1 month back. At admission patient was conscious, febrile and had diffuse upper abdominal pain which was severe in intensity. Abdomen was distended and bowel sounds were absent. There was tender hepatomegaly. Spleen was not palpable. No free fluid was detected clinically. There was no past history of diabetes, hypertension, and abdominal/biliary surgery. His investigations showed leukocytosis (total leukocyte count = 18,000/mm3). Serum lipase and amylase were markedly elevated (1788？mg/dL and 1365？mg/dL, resp.). X-ray abdomen showed distended bowel loops. Ultrasonography (USG) of abdomen was done which revealed an abscess cavity of 8 × 8 × 7？cm3 in the right lobe of liver situated near the surface of the liver. Serum IgG Entamoeba histolytica was positive. No gall bladder or common bile duct stones were seen in the USG. He had mild hypocalcaemia (serum calcium level = 8.2？mg/dL). Serum lipid profile, glucose, liver function tests, renal function tests, and thyroid profile were within normal limit. X-ray chest was unremarkable except for prominent bronchovascular markings. Arterial blood gas analysis was almost normal except for low calcium level. On day 2 of hospital admission, contrast enhanced CT (CECT) scan of abdomen was done which showed a large right lobe liver abscess associated with edematous pancreas without any necrosis or acute fluid collections (Figure 1). The modified CT severity index (CTSI) was 4/10. No fistulous communication between liver and pancreas or other organs could be demonstrated in the CECT abdomen. Patient was managed with intravenous fluid, intravenous antibiotics, that is, metronidazole and meropenem. Liver abscess was aspirated under USG guidance and about 250？mL of anchovy sauce pus was aspirated. Gram stain and culture of the pus were negative. The pus was also examined for pancreatic enzymes which were within normal limits. On day 2 of hospitalization