Recurrent amebic liver abscesses over a 16-year period: a case report

Abstract

BackgroundAmebic 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.Case presentationA 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.ConclusionWe 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.

Recurrent amebic liver abscesses despite metronidazole treatment: A rare case report

“…Another study showed a 72% prevalence of asymptomatic luminal colonization of E. histolytica at the initial presentation of ALA. Of these patients with concomitant intestinal infection, treatment with metronidazole was insufficient to eradicate intestinal infection in greater than 50% of patients, despite resolution of the liver abscess 9 . Additionally, metronidazole therapy without a subsequent luminal agent is ineffective in addressing asymptomatic colonization 10–12 . E. histolytica can develop metronidazole resistance in vitro, but rates of clinical resistance are unclear 13 .…”

“…9 Additionally, metronidazole therapy without a subsequent luminal agent is ineffective in addressing asymptomatic colonization. [10][11][12] E. histolytica can develop metronidazole resistance in vitro, but rates of clinical resistance are unclear. 13 Another possibility considered for the patient's recurrence was close contact with asymptomatic carriers, such as his family.…”

Recurrent amebic liver abscesses despite metronidazole treatment: A rare case report

“…Moreover, metronidazole therapy alone is insufficient without a subsequent luminal agent to treat asymptomatic colonization (Table 1). [8][9][10] One study in India found a recurrence rate of 9% within two years among patients not treated with a luminal agent. 11 Another study showed a 72% prevalence of asymptomatic luminal colonization of E. histolytica at initial presentation of ALA. Of these patients with concomitant intestinal infection, treatment with metronidazole was insufficient to eradicate intestinal infection in greater than 50% of patients despite resolution of the liver abscess.…”

Entamoeba histolytica and amoebic liver abscess in northern Sri Lanka: a public health problem

“…Hematogenous spread to the brain can also occur, resulting in cerebral amoebiasis, but is exceedingly rare [86]. Finally, the risk of recurrent infection, despite adequate treatment has also been previously described in the literature [87].…”