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Friday 23 May 2014

CASE 256: LIVER FUNGAL INFECTION in HIV-INFECTED PATIENT, Dr LÊ ĐÌNH VĨNH PHÚC, Dr VÕ NGUYỄN THÀNH NHÂN, MEDIC MEDICAL CENTER HCMC, VIETNAM

A 30 year-old married woman, suffered from weight loss, fatigue, not fever, not abdominal pain. She has scanned by abdominal ultrasound at a province hospital detecting multifocal lesions in liver. Her doctor thought her liver hemangioma.

At MEDIC center, ultrasound scanning detected multi-hyperechoic masses with regular border, no vascular proliferative, no around liver parenchyma edema, no necrosis fluid, size of 0.5 to 2cm in right and left lobe.





CT Scan of liver was done with many reduced density lesions in the right and left lobe. The lesions were slight contrast enhancement. Some lesions were higher than in the center area.






Blood test with WBC normal, transaminases slight increase, HBsAg negative, anti-HCV negative. The important noticeable result is that anti-HIV positive (ELISA).

The findings of ultrasound, CT Scan and blood test suggested liver fungal infection in HIV-infected patient. This patient was treated with anti-fungal drugs. Fungal infection is a common opportunistic disease in HIV-infected patient. Among the fungal opportunistic infections, Coccidioides immitis and Histoplasma capsulatum are those most likely to involve the liver [1]. Fungal liver abscess diagnosis remains a challenge for diagnostic imaging and clinical.

What is your suggestion of diagnosis?

References:
1.  Anthony S. Fauci; H. Clifford Lane (2010). “Human immunodeficiency virus disease: AIDS and related disorders”. Harrison’s infectious diseases. Mc Graw Hill. p. 847







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