Thrombosis of the inferior vena cava and right atrium: a rare complication of an amebic liver abscess in Dakar, Senegal

The liver is the most common site of extra-intestinal amebiasis. Amebic liver abscesses can be complicated by rupture, migration to adjacent organs or, more rarely, vascular thrombosis. The purpose of this report is to describe the case of a 52-year-old Senegalese man hospitalized for painful hepatomegaly associated with asymmetric bilateral pulmonary consolidation and fever. Abdominal ultrasound revealed a large abscess in the left lobe of the liver with a non-obstructive thrombus extending from the inferior vena cava to the right atrium. Doppler cardiac ultrasound depicted extensive right atrial thrombus formation. Chest radiography showed opacities in both lungs. Sputum smear tests for tuberculosis were negative, but amebic serology was positive. Treatment consisted of a combination of antibiotics (metronidazole/amoxicillin/clavulanic acid), curative heparin therapy, and abscess drainage. Complications during treatment included thrombosis of the right chambers of the heart and a suspected pulmonary embolism. Outcome was favorable and the thrombi disappeared. The available literature confirms the rarity of this complication, which can have severe consequences due to embolism.