Encysted
Immune System
0
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F1.jpg"}},{"insert":"\n\n"},{"insert":"You\u0027re in early today, relaxing in your office with the morning paper and an especially good coffee.\r\n \r\nJust as you take the last sip, the nurse announces your first patient for the day.\n"}]}
1
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F2.jpg"}},{"insert":"\n\n"},{"insert":"34-year-old Jo\u00e3o Lucas is a recent migrant from Porto Alegre, in southern Brazil.\r\n \r\n\u0022My stomach has been hurting for a while, doctor. I\u0027ve also had nausea and have been feeling quite bloated, all this for around two months now,\u0022 he says.\n"}]}
2
{"ops":[{"insert":"You learn that his symptoms have been intermittent, and that he has been taking acetaminophen (paracetamol) for the pain. His medical history is otherwise unremarkable.\n"}]}
3
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F4.jpg"}},{"insert":"\n\n"},{"insert":"You request to examine Jo\u00e3o, to which he consents. \r\n \r\nHe has slight tenderness in the right upper quadrant, along with mild hepatomegaly of ~3cm below the right costal margin.\r\n \r\nHe does not complain of itching or appear icteric.\n\nHis blood pressure is 120\/80 mmHg, with a regular pulse of 84 bpm, and a temperature of 37.1 \u2103 (98.78 \u2109). His BMI is 28 kg\/m2.\n"}]}
4
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F5.jpg"}},{"insert":"\n\n"},{"insert":"\u0022It looks your liver is mildly enlarged\u0022, you tell him. \u0022We should investigate this further with some blood tests and an abdominal ultrasound.\u0022\r\n\r\n\u0022Sure, doctor,\u0022 he responds, worriedly.\n"}]}
5
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F6.jpg"}},{"insert":"\n\n"},{"insert":"You send blood samples to the lab and perform the ultrasound, which reveals a well-defined cyst measuring 10 \u00d7 8 cm with a thick wall (about 5- 10 mm) in the right hepatic lobe. No other abnormalities are seen.\n"}]}
6
{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M28_F7.jpg"}},{"insert":"\n\n"},{"insert":"Jo\u00e3o\u0027s bloodwork returns as follows:\r\n\r\nWBC: 8400 (4,500 - 10,500)\r\nNeutrophils : 51% (40 - 70)\r\nLymphocytes: 32% (25 - 45)\r\nEosinophils: 13% (2 - 8)\r\nHb: 12.6 g\/dL (13 - 17)\r\nHct: 38.5%\r\nPlt 221,000\/mm3 (15,000 - 400,000)\n\nCRP: 3.2 mg\/L (\u003C6)\r\nALT: 45 U\/L (5 - 45)\r\nAST: 51 U\/L (5 - 60) \r\nProthrombin Time: 90%\r\nUrea: 28 mg\/dL (10 - 50) \r\nCreatinine: 0.8 mg\/dL (0.3 - 1.1)\n"}]}
7
{"ops":[{"insert":"What do you suspect?\n"}]}
1. A simple liver cyst
2. A hydatid cyst of the liver
3. A cystic tumor
9
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