'Unusually Large' Liver Abscess Found In 14 Covid-19 Recovered Patients In Delhi, 1 Dead

Thirteen of these patients were successfully treated with antibiotics, metronidazole drugs, and the removal of pus from the liver, while one patient with large boils succumbed.

New Delhi: There are many symptoms and ailments reported in patients recovering from Covid-19, and recently 14 unusual cases of liver abscesses have been observed in patients at Sir Ganga Ram Hospital in Delhi. After recovering from Covid-19 infection in the last two months, cases of abnormally large and full-bodied liver abscess have come to light in 14 patients, according to the hospital. These patients were in the age group of 28-74 years, including 10 males and four females. All of these patients had fever and upper abdominal pain and three patients also had bleeding with black stools.

Eight of these patients were given steroids for clinical management of Covid-19 symptoms. Of these, six patients had several large abscesses on either side of the liver, of which five patients had large abscesses (> 8 cm), with the largest being 19 cm in size.

According to Professor Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, who is treating these patients at Sir Gangaram Hospital, found that the patients, who were 'immunocompetent' after recovering from Covid were found to have both parts of their liver filled with too much pus. It required immediate drainage and hospitalization.

 In May, the hospital reported around 14 cases of liver abscess in patients after three weeks of their recovery from Covid-19. Usually these liver abscesses are common infections. “Single abscesses are on the right side of the liver, but this time we were amazed that the abscess was in both lobes and was very large and in some people the whole liver was full of pus.” Arora added. Three patients with blood in the stool had ulcers in the large intestine which was seen detected through colonoscopy. The average duration between Covid-19 symptoms and diagnosis of liver abscess was 22 days.

Thirteen of these patients were successfully treated with antibiotics, metronidazole drugs, and the removal of pus from the liver, while one patient with large boils succumbed due to heavy bleeding in the abdomen after rupture of pus in the liver lobe. The rest of the patients are stable and have been discharged.

Arora said, "We found many more large boils in patients, that are unusual for an immunocompetent person. Due to the use of steroids and suspicion of liver abscess in patients recovering from Covid in this epidemic, and delay in treatment, many large abscesses probably developed in these patients.”

According to the doctor, an abscess filled with pus in the liver is usually caused by a parasite called ' Entamoeba histolytica’ which is spread by contaminated food and water.

Entamoeba histolytica is a common parasite in countries with poor sanitation services. These parasites cause amoebiasis, an intestinal infection also called amoebic dysentery. Once infected, the parasite can travel from the intestines to the liver through the bloodstream and cause liver abscesses. Usually these boils are solitary and not very large. It is unusual and worrying to have so many boils due to Covid-19 in such a large size and in the liver. Abdominal ultrasonography is performed for fever and related symptoms in patients. Poor nutrition, immune status (e.g. in patients with HIV and cancer), steroid use, and infection by amoebae cause boils in the liver of patients, he added.

If there is pain after recovering from the infection, one should see a doctor immediately.

 “We believe that this type of infection is not normal when you are recovering from covid because of covid or because of the steroids given to it or because of underline diabetes. So whenever there is fever, there is pain, If there is pain in the upper part of the abdomen, attention must be paid to liver abscess, ” said Arora.