He complains of fever, rigors and headache

A 24 year old man has recently returned from India. He complains of fever, rigors and headache.
On examination he had a temperature of 38°C, a blood pressure of 120/70 mmHg, a pulse of 110 bpm. His abdomen was tender in right upper quadrant.
Investigations showed:
Hb - 10.5 g/dL
WBC - 13.5 x 109/L
Neutrophils - 11.2 x 109/l
Platelets - 360 x 109/L
Blood film No malaria parasites seen
Alk Phos - 420 U/L
AST - 60 U/L
CRP - 110 mg/L
Stool culture - Negative
Chest x-ray: Small right pleural effusion
Which of the following investigations would be of diagnostic value?

  1. Anti endomysial antibody

  2. Typhoid serology

  3. Stool for ova, cysts parasites

  4. Ultrasound scan of abdomen

  5. Colonosocopy

View Explanation

The ultrasound would determine if there is a pyogenic liver abscess or amoebic liver abscess. The clinical history with associated pleural effusion suggests that an abscess needs to be excluded (and drained if necessary).