[An amebic liver abscess; early suspicion, late detection]

Area of Science:

• Hepatology
• Infectious Diseases
• Medical Diagnostics

Background:

• Travel to endemic regions like the Caribbean is a risk factor for parasitic infections.
• Amoebic liver abscess (ALA) is a serious complication of Entamoeba histolytica infection.
• Prompt diagnosis and treatment are crucial for patient recovery.

Observation:

• Two male patients, aged 38 and 26, presented with upper abdominal pain, malaise, and fever 1.5-5 months post-Caribbean travel.
• Initial diagnostic efforts, including ultrasonography, were inconclusive.
• Repeated ultrasonography eventually revealed liver abscesses.

Findings:

• The diagnosis of amoebic liver abscess relies on clinical presentation, serology, and imaging.
• Early-stage abscesses may yield negative serological tests and normal ultrasonographic findings.
• These negative initial findings should not rule out ALA if clinical suspicion remains.

Implications:

• Clinicians must maintain a high index of suspicion for amoebic liver abscess in patients with relevant travel history, even with non-specific initial findings.
• Repeated diagnostic imaging may be necessary for early detection.
• Delayed diagnosis can lead to prolonged illness and potential complications.