96.A 40-year-old woman presents to the ED complaining of fever and 1 day
of increasingly severe pain in her RUQ. She denies nausea or vomiting and
has no history of fatty food intolerance. The patient returned from a trip to
Mexico 6 months ago. About 2 weeks ago she experienced intermittent diar-
rhea with blood-streaked mucus. Her BP is 130/80 mm Hg, HR is 107 beats
per minute, temperature is 102°F, and RR is 17 breaths per minute. Physical
examination reveals decreased breath sounds over the right lung base.
Abdominal examination shows tenderness to percussion over the RUQ and
normal active bowel sounds. There is no Murphy sign. Her WBC is 20,500/μL.
Chest radiograph reveals a small right-pleural effusion. Which of the following
is the most likely diagnosis?
a. Amebic abscess
b. Cholecystitis
c. Cryptosporidium
d. Enterobiasis
e. Pyogenic abscess
90 Emergency Medicine