SHM Converge Scientific Abstract ePoster Gallery-Traveler With an Amoebic Liver Abscess: Diagnostic Delay

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This case describes a 57-year-old previously healthy man who presented with 8 days of high fever, fatigue, and abdominal pain. He had traveled to Mexico one year earlier and Costa Rica six months earlier. Initial labs showed leukocytosis and elevated inflammatory markers. Imaging with CT and MRI revealed a hepatic abscess/loculated liver lesion, and interventional radiology drainage produced purulent material.<br /><br />Despite concern for infection, both blood and abscess cultures were negative, which initially complicated diagnosis. Infectious Disease recommended additional testing, and GI PCR of the abscess fluid was positive for amebiasis. Confirmatory studies also showed positive serum IgG and stool PCR, establishing the diagnosis of amebic liver abscess (ALA). He was treated with 9 days of IV piperacillin-tazobactam, then transitioned to levofloxacin, metronidazole, and paromomycin for 7 days to eradicate intestinal colonization. The drain was removed before discharge, and total hospitalization lasted 12 days.<br /><br />The case highlights three important teaching points:<br />1. Amebic liver abscess may occur without gastrointestinal symptoms, and many patients do not have diarrhea, making clinical suspicion lower in non-endemic settings.<br />2. Abscess cultures are often sterile because ALA contains necrotic tissue with few trophozoites, so negative cultures do not exclude the diagnosis.<br />3. Symptoms can appear months to years after exposure, so a remote travel history remains highly relevant.<br /><br />Overall, the case emphasizes that in patients with liver abscess and prior travel to endemic areas, early serologic testing or multiplex GI PCR can improve diagnostic yield and reduce unnecessary prolonged broad-spectrum IV antibiotic therapy.

Asset Subtitle

Yuhong Yang

Meta Tag

Author List Yuhong Yang

Category Clinical Vignettes

Concept Amebic Liver Abscess

Concept Amebiasis

Concept Metronidazole

Concept Pyogenic Hepatic Abscess

Concept Abscess Culture

Distinguished Non-Finalist

Presenter Organization Mount Sinai West Hospital

Presenting Author Yuhong Yang

Track Adult

Keywords

amebic liver abscess

Entamoeba histolytica

hepatic abscess

travel history

negative cultures

GI PCR

serum IgG

metronidazole

paromomycin

liver lesion

Amebic Liver Abscess

Amebiasis

Metronidazole

Pyogenic Hepatic Abscess

Abscess Culture