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Snowflake In The Liver Case Study

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Snowflakes in the liver
Case presentation:
A 43-year-old male patient was admitted to the Emergency Department ward for general malaise with abdominal pain in the right upper quadrant, breath employee, already present two months before and actually increase. There was no sign of fever, pathologic lymphadenopathy, jaundice or other symptoms. At physical examination the patient appeared lucid, well spatial/temporal-oriented, afebrile, hemodynamically stable (AP 100/70 mmHg, HR 68 bpm), weight 73 Kg, height 180 cm; all examinations were in the normal range, except for mild deep pain in right upper quadrant and the right shoulder.
Past History:
He was born in Portugal, lived in Switzerland from 1983 to 2000, then in France from 2000 to 2007 and …show more content…

An abdominal CT-scan showed calcification with a “snowflake appearance”in the liver (figures 1-2); for our radiologic team these are suggestive for signs of chronic hepatic Brucellosis5. The patient was seen twice at our department to undergo liver fine-needle biopsy of the major hepatic lesion, negative for helminths (Trichinellaspp, Toxocariasis, Echinococcusgranulosus, Fasciolaspp, Anguillosisspp, Cisticercosisspp), Protozoa, Parasites and …show more content…

Despite antibiotics3, bacteria are sometimes difficult to eradicate and if the disease is very aggressive4, surgery may be required to treat patients5. We’ve found a typical case of a relatively rare disease that took some time to be properly diagnosed. Following current guidelines, we starting first with antibiotic treatment and then, given the persistence of the disease, with a more aggressive surgical option3-4. It is known that if the disease persists despite antibiotic therapy, as in this case, is adequate treat the patient surgically5. We wondered if we had had to intervene early with surgery, in order to rapidly eradicate the disease, but at the moment the evidences point to intervene only in case of persistence of the disease despite maximal medical therapy. Further evidences are needed to acquire more knowledge about the better treatment, especially to identify patients at risk of relapse, in order to rapidly change on surgical option rather than continue for a long time with antibiotic therapy. We hope that this event will make a contribution in this

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