Adaptive approach to diagnosis of amebic liver abscess in non-endemic areas

Entamoeba histolytica infections range from asymptomatic intestinal amebiasis to more severe syndromes like invasive colitis or hepatic abscess. While diagnostic tests available for assessing these infections have evolved, the optimal use of newer diagnostics like enteric multiplex Polymerase Chain Reaction (PCR) panels has not been fully established. Here we describe the case of a 34-year-old male with an amebic liver abscess (ALA) that was diagnosed via multiplex Gastrointestinal (GI) PCR panel on formed stool and subsequently confirmed by testing liver abscess fluid (off-label) on the same multiplex GI PCR panel leading to rapid diagnosis and targeted treatment modification with excellent outcome. In E. histolytica non-endemic regions the likelihood of incidental luminal amebiasis is low, so identification of the parasite by stool PCR on a multiplex GI PCR panel in the setting of an undifferentiated hepatic abscess should be highly predictive of ALA.