To the Editor.
—Pain over the right-upper quadrant, fever, and tender hepatomegaly are our immediate associations when the possibility of an amebic liver abscess is considered.1 Indeed, a typical series shows that these symptoms are an almost constant feature of the disease; each of them are present in 86% to 94% of the patients,2 suggesting that asymptomatic disease is highly unlikely. We report a case of multiple large amebic liver abscesses that were entirely asymptomatic.A 66-year-old Egyptian-born man with a history of smoking, hypertension, diffuse atherosclerotic cardiovascular disease, and adult-onset diabetes mellitus (diet controlled), was admitted for paroxysmal atrial fibrillation. A slight nontender hepatomegaly was found as well as an erythrocyte sedimentation rate of 137 mm/h (Westergren), serum alkaline phosphatase level of 240 U/dL, with normal bilirubin and transaminase values, and marked hyperglobulinemia (serum albumin, 37 g/L [3.7 g/dL]; globulin, 64 g/L [6.4 g/dL]). Results of a
Schattner A, Hai E, Bentwich Z. Silent Amebic Liver Abscess. Arch Intern Med. 1987;147(11):2054–2056. doi:10.1001/archinte.1987.00370110182030