Amebic liver abscess

S. F. Abuabara, J. A. Barrett, T. Hau and O. Jonasson

Amebic liver abscess was seen in 35 patients over a ten-year period at Cook County and the University of Illinois hospitals, Chicago; 32 had immigrated from an area of endemic amebiasis, but three were natives of Chicago. Typically they had right upper-quadrant abdominal pain and fever of short duration (nine days); on physical examination, upper abdominal tenderness and hepatomegaly were usually present. The diagnosis was confirmed by liver scan, serologic studies, aspiration of "anchovy paste" from the abscess, and/or a favorable response to specific antiamebic therapy. Most were solitary abscesses in the right lobe of the liver. Metronidazole treatment alone was adequate in 24 of 29 patients (83%). Nine patients underwent percutaneous or surgical drainage of the abscess owing to incorrect diagnosis (three), persistent pain and fever after medical treatment (three), expanding left lobe abscess (two), and for diagnosis (one). Mortality was 5.7% (two patients). Owing to current immigration patterns amebic liver abscess should be considered in the differential diagnosis of patients with right upper-quadrant pain and fever. The diagnosis should be confirmed with a liver scan and serologic study for amebiasis.