Amoebic Abscess Following a Long-Past Stay Abroad

A 52-year-old female patient presented as an emergency with fever, right-sided upper abdominal pain, and fatigue. She reported having been on vacation in Colombia 9 months previously (prevalence of amoebic infection there, 4–12%), during which time she had left tourist facilities. The patient reported no diarrhea. On ultrasound, a large anechoic mass was visible in the right lobe of the liver. This did not meet the criteria for an echinococcus cyst. Computed tomography was then performed (Figure). Under the working diagnosis of amoebic abscess without symptoms of enteritis (60% of cases), intravenous antibiotic therapy with metronidazole (10 mg/kgKG 3 ×/day) was initiated according to guidelines; this was supplemented with tazobactam (4.5 g i.v. 3 ×/day) to cover other possible pathogens until serological evidence was available. Stool cultures were negative, but elevated IgG-FST titers for E. histolytica (1:640) were confirmed serologically, prompting oral therapy with paromomycin 25 mg/kg bodyweight for 7 days. The patient has been clinically symptom-free since completing treatment, and ultrasound has shown the abscess to be resolving. Complete resolution of the abscess may take several months.

Figure

Axial CT slices in soft tissue window following intravenous contrast administration in the venous phase

Dr. med. Andreas Benedikt Bauer, Bundeswehrkrankenhaus Ulm

PD Dr. med. Christian Beltzer, Klinik für Allgemein-, Viszeral- und Thoraxchirurgie Bundeswehrkrankenhaus Ulm

Dr. med. Christoph Zischek, Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Bundeswehrkrankenhaus Ulm, [e-mail]

Conflict of interest statement: The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Bauer B, Beltzer C, Zischek C: Amoebic abscess following a long-past stay abroad. Dtsch Arztebl Int 2023; 120: 490. DOI: 10.3238/arztebl.m2022.0388