Amoebic liver abscess with negative serologic markers for Entamoeba histolytica: mind the gap

• Published in: Infection 2012-02, Vol.40 (1), p.87-91
• Main Authors: Marn, H., Ignatius, R., Tannich, E., Harms, G., Schürmann, M., Dieckmann, S.
• Format: Article
• Language: English
• Subjects: Abscesses; Administration, Oral; Adult; Agglutination Tests; Amoeba; Antibodies; Antigens, Protozoan - isolation & purification; Antiprotozoal Agents - therapeutic use; Blood culture; Case Report; Ciprofloxacin; Ciprofloxacin - therapeutic use; Cysts; Entamoeba histolytica; Entamoeba histolytica - isolation & purification; Entamoebiasis - diagnosis; Entamoebiasis - drug therapy; Entamoebiasis - parasitology; Entamoebiasis - pathology; Etiology; Family Medicine; Feces; Fever; Fluorescent Antibody Technique; General Practice; Germany; Humans; Immunoenzyme Techniques; Infection; Infectious Diseases; Internal Medicine; Liver; Liver - diagnostic imaging; Liver - parasitology; Liver - pathology; Liver Abscess, Amebic - diagnosis; Liver Abscess, Amebic - drug therapy; Liver Abscess, Amebic - parasitology; Liver Abscess, Amebic - pathology; Male; Medicine; Medicine & Public Health; Metronidazole; Metronidazole - therapeutic use; Microscopy; paromomycin; Paromomycin - therapeutic use; Serology; Sweat; Travellers; Ultrasonography; Ultrasound
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-011-0157-x

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.