title: Recurrent amebic liver abscesses over a 16-year period: a case report.
abstract: BACKGROUND
  Amebic liver abscess is a rare disease in high-income countries. Recurrence of amebic liver abscess is even rarer with only a few previous reports. Here we present a patient who developed three subsequent amebic liver abscesses over a sixteen-year period.
  
  
  METHODS
  A Caucasian male developed recurrent amebic liver abscesses, when aged 23, 27 and 39 years. Only on the first occasion did this coincide with a recent visit to the tropics. The patient received adequate treatment during each episode. Possible explanations are persistent asymptomatic carrier state, cysts passage in his family, re-infection or chance.
  
  
  CONCLUSIONS
  We describe the unusual case of a healthy male who developed recurrent amebic liver abscesses over a long period despite adequate treatment. Possible pathophysiological explanations are explored.
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands.|Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: D
authors.initials: D
authors.lastname: Creemers-Schild
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands.
authors.forename: P J J
authors.initials: PJ
authors.lastname: van Genderen
authors.affiliation: Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: L G
authors.initials: LG
authors.lastname: Visser
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center and Institute for Tropical Diseases, Rotterdam Harbour Hospital, MC, Room Na-901K (Secr. Office), P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. j.vanhellemond@erasmusmc.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Hellemond
authors.affiliation: Institute for Tropical Diseases, Harbour Hospital, Rotterdam, The Netherlands.
authors.forename: P J
authors.initials: PJ
authors.lastname: Wismans
mesh_terms: D000328:Adult; D005663:Furans / Q000627:therapeutic use; D006801:Humans; D008101:Liver Abscess, Amebic / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D012008:Recurrence; D055815:Young Adult
chemical_list: D005663:Furans; D008795:Metronidazole; C004932:diloxanide furoate
keywords: Amebiasis; Carrier state environment; Entamoeba histolytica; Immune response; Relapse; Treatment