A Lilliputian army under the floorboards: persistent delirium with complete though prolonged recovery

BMJ Case Rep. 2014 May 2;2014:bcr2013202639. doi: 10.1136/bcr-2013-202639.


We report the case of an 83-year-old man who presented with a history of fluctuating delirium of insidious onset, secondary to an amoebic liver abscess more than 30 years after acute exposure. We describe a 2-year clinical journey that started with a fall and was additionally complicated by severe weight loss and acute kidney injury (AKI). The likely prognosis for such a combination of comorbidities in an older person is for lasting morbidity, institutionalisation and significant mortality. However, the case demonstrates that with timely assessment and care complete recovery is possible though it may take many months. It reminds us of the catalytic implications of falls for older persons and to maintain a differential diagnostic approach to delirium of insidious onset avoiding misdiagnosis as dementia with which it may be associated. Our case report includes extracts from the patient's own account providing added insight into such experiences.

Publication types

  • Case Reports

MeSH terms

  • Accidental Falls*
  • Acute Kidney Injury / complications
  • Aged, 80 and over
  • Amebicides / therapeutic use*
  • Delirium / etiology
  • Delirium / therapy*
  • Hallucinations / etiology
  • Humans
  • Liver Abscess, Amebic / complications
  • Liver Abscess, Amebic / drug therapy*
  • Male
  • Paromomycin / therapeutic use*
  • Recovery of Function


  • Amebicides
  • Paromomycin