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Am J Trop Med Hyg. 2010 November 5; 83(5): 961.
PMCID: PMC2963951

Amebic Liver Abscess

A 45 year-old woman presented with a 6-week history of constant right upper quadrant abdominal pain, 20-lb weight loss, and worsening fevers. The patient had immigrated to the United States from Mexico 7 years earlier. She was febrile, experienced pain with light palpation of the right upper quadrant, and had normal serum transaminases, normal alkaline phosphatase, and mildly elevated total bilirubin of 1.1 mg/dL. Abdominal computerized tomography revealed contiguous peripherally enhancing, thick-walled, hypodense hepatic dome abscesses measuring 9.5 × 6.1 cm (Figures 1 and and2)2) Entamoeba histolytica serology was positive, and the size of the lesions halved after 4 days of metronidazole and symptoms rapidly resolved. Entamoeba histolytica is a protozoan that can cause asymptomatic colonization, amebic colitis, or extraintestinal abscesses.13 Transmission of infective cysts is fecal-oral, and patients usually have a history of exposure from an endemic area. Symptoms include a history of fever and right upper quadrant pain.1,3 Diagnosis can be aided with imaging studies and confirmed with serological studies and real-time polymerase chain reaction assays.3,4 Invasive disease should be treated with metronidazole for 10 days and paromomycin to eliminate colonization for 7 days.3 In rare cases, surgical intervention may be necessary.3

Figure 1.
Initial abdominal CT scan demonstrating hepatic abscess.
Figure 2.
Initial abdominal CT scan demonstrating hepatic abscess.

Footnotes

Authors' addresses: Kanishka W. Garvin, University of Washington, Seattle, WA, E-mail: ude.notgnihsaw.u@nivragwk. James H. Willig, University of Alabama at Birmingham, Birmingham, AL, E-mail: ude.bau@gilliwj.

References

1. Li E, Stanley SL., Jr Amebiasis. Gastroenterol Clin North Am. 1996;25:471–492. [PubMed]
2. Petri WA, Singh U, Ravdin JI. In: Tropical Infectious Diseases: Principles, Pathogens, and Practice. First edition. Guerrant R, Walker DH, Weller PF, editors. Philadelphia, PA: WB Saunders; 2005. p. 685. (Enteric amebiasis).
3. Stanley SL. Amoebiasis. Lancet. 2003;361:1025–1034. [PubMed]
4. Haque R, Kabir M, Noor Z, Rahman SM, Mondal D, Alam F, Rahman I, Al Mahmood A, Ahmed N, Petri WA., Jr Diagnosis of amebic liver abscess and amebic colitis by detection of Entamoeba histolytica DNA in blood, urine, and saliva by real-time PCR assay. J Clin Microbiol. 2010;9:156. [PMC free article] [PubMed]

Articles from The American Journal of Tropical Medicine and Hygiene are provided here courtesy of The American Society of Tropical Medicine and Hygiene