Issue: 2020 > September > photo quiz

Septicaemia and liver abscesses after a skin ulcer in the tropics

D.A.R. Castelijn, S.G. Vreden, C.R.C. Doorenbos, J. Kropff
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A 40-year-old, previously healthy man presented to the internal medicine outpatient clinic in Paramaribo, Suriname with a six-week history of intermittent fever. Approximately four days prior to onset of his fever, he had waded through stagnant, fresh water with a leg wound caused by blunt force trauma. Physical examination revealed a non-septic patient with pain in the right upper abdomen and a healing skin ulcer on the left shin (figure 1). Laboratory results showed evident inflammation with leucocytosis 21.9 x 109/l [4.5-11 x 109/l] and C-reactive protein 285 mg/l [0-5 mg/l]. Liver enzymes were normal and HIV screening was negative. Abdominal CT scan showed multiple liver abscesses, the largest was 41 mm in diameter (figure 2A). Because of the subpleural localisation of this abscess, drainage was deemed too risky. Culture of aspirated pus showed growth of a single species of bacteria with a distinct violet pigment (figure 2B). The blood culture yielded the same microorganism.  


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