Recurrence of hepatic amebiasis after successful treatment with metronidazole

A patient with an amebic liver abscess had an incomplete response to an initial course of metronidazole, but subsequently responded to a prolonged course of the agent. Recurrence of disease in the contralateral hepatic lobe responded to chloroquine along with a luminicide. We took the initial failure of metronidazole to be secondary to either the advanced nature of the disease or the development of partial resistance to metronidazole. The recurrence was the result of reinfection of the liver by persistent organisms in the bowel, emphasizing the importance of giving a lumicide in the initial treatment of this lesion.