Eosinophilic Abdominal and Hepatic Abscesses in Kurdish Iraq: An Emerging Disease Largely of Uncertain Cause.
Hemmin Hassan, Runnak Majid, Alton Farris, Jeannette Guarner, Michael Hughson. Shorsh General and the University Teaching Hospital, Sulaimaniyah, Iraq; Emory University, Atlanta, GA
Background: Regional conflicts and the urban migration of rural populations are altering disease patterns of in many countries of the Middle East. Sulaimaniyah in the East Kurdish region of Northern Iraq has experienced an outbreak of eosinophilic abdominal abscesses that were not seen prior to 2009. Previously, eosinophilic liver abscesses have gained little attention in the medical literature.
Design: Eosinophilic abdominal abscesses diagnosed in Sulaimaniyah's Shorsh General and the University Teaching Hospitals in 2009 and 2010 were studied together with patient clinical data.
Results: Five male and 8 female patients had a median age of 27 (range: 1.5-56 years). All lived in urban Sulaimaniyah. Clinical findings included right subchondral pain, fever, malaise, and blood eosinophilia. None had pulmonary symptoms. Stools were negative for ova and parasites. The abscesses were lined by a granulomatous reaction with giant cells surrounding central necrosis and an eosinophilic exudate containing Charcot-Leyden crystals. Ten patients had hepatic abscesses that were localized multilocular 3-5cm lesions in 7 patients and diffuse approximately 0.5-1 cm lesions in 3 patients. One patient, a 1.5 year old child, had a 3 cm anterior abdominal wall abscess without apparent liver involvement. Four patients had intestinal obstruction due to cecal (2 patients), hepatic flexure, or gastric abcesses. Features suggestive of basidiobolomycosis were found in a patient with cecal and hepatic abscesses. Ova resembling those of Fasciola were found in liver granulomas of another patient. In eleven specimens, no organisms could be seen. In the study period, 19 hydatid liver cysts, were surgically removed. Eosinophilic abscesses were not found in patients with hydatid disease. In the two other large cities of the Kurdish region, one eosinophilic liver abscess was seen in Duhuk in 2010 but not before, and none have been seen in Erbil.
Conclusions: Since 2009, eosinophilic abdominal abscesses, predominantly of the liver, have emerged as a previously unrecognized disease in the Eastern region of Northern Iraq. Although in most cases an etiologic agent has not been identified, parasites and fungal infections are suspected. They are presently seen with more than half the frequency but do not overlap with hydatid liver cysts, the major clinical parasitic disease of Iraq.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 221, Wednesday Afternoon