title: Amoebic liver abscess with negative serologic markers for Entamoeba histolytica: mind the gap!
abstract: A 38-year-old male German traveller returning from Asia presented with fever, night sweats and abdominal complaints. Abdominal ultrasonography revealed several fast-growing abscesses of the liver. Three blood cultures as well as serologic investigations for the detection of antibodies to Entamoeba histolytica, performed on day 3 and 7 after the onset of clinical symptoms, remained negative. Stool microscopy revealed the presence of amoeba cysts compatible with E. histolytica infection. Taking both the amoebic and bacterial etiology of the abscesses into consideration, the patient was treated with metronidazole and ciprofloxacin followed by paromomycin. Antibodies to E. histolytica tested positive shortly after anti-amoebic therapy was initiated. The patient fully recovered, and ultrasound follow-up showed complete resolution of the abscesses within 50 days. This case leads to the conclusion that amoebic liver abscess should be considered despite negative amoeba serology and that ultrasonography is an important diagnostic tool for the early diagnosis of extraintestinal amoebiasis.
authors: Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, Spandauer Damm 130, Haus 10, 14050 Berlin, Germany. heiko.marn@charite.de
authors: H
authors: H
authors: Marn
authors: R
authors: R
authors: Ignatius
authors: E
authors: E
authors: Tannich
authors: G
authors: G
authors: Harms
authors: M
authors: M
authors: Schürmann
authors: S
authors: S
authors: Dieckmann
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000372:Agglutination Tests; D000953:Antigens, Protozoan / Q000302:isolation & purification; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D002939:Ciprofloxacin / Q000627:therapeutic use; D004748:Entamoeba histolytica / Q000302:isolation & purification; D004749:Entamoebiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology; D005455:Fluorescent Antibody Technique; D005858:Germany; D006801:Humans; D007124:Immunoenzyme Techniques; D008099:Liver / Q000000981:diagnostic imaging / Q000469:parasitology / Q000473:pathology; D008101:Liver Abscess, Amebic / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D010303:Paromomycin / Q000627:therapeutic use; D014463:Ultrasonography
chemical_list: D000953:Antigens, Protozoan; D000981:Antiprotozoal Agents; D008795:Metronidazole; D002939:Ciprofloxacin; D010303:Paromomycin