Extra-intestinal amebiasis: clinical presentation in a non-endemic setting

37/38 patients with reciprocal titers > or = 512 against Entamoeba histolytica in Denmark over a 5-year period were evaluated retrospectively in order to establish the clinical profile of extra-intestinal amebiasis in a non-endemic area. 24 of these had extra-intestinal amebiasis, all presenting 1 or more amebic liver abscesses on ultrasonography. Fever was the most common finding, present in 91% of the cases. The most striking observation was the lack of both abdominal pain and tenderness in 22% of the patients with liver abscess. Pulmonary symptoms and abnormal chest X-rays were each recorded in 45% of the cases. Liver abscesses with or without pulmonary involvement were the only extra-intestinal manifestations recorded. The condition was initially misconceived in more than half the cases, but most of the patients responded well once treatment with metronidazole was started.