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Amoebic Liver Abscess — SCE Infectious Diseases MCQ

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ModerateTropical & Imported InfectionsAmoebic Liver AbscessSCE Infectious Diseases

A 48-year-old man presents to the emergency department with 3 days of right iliac fossa pain, fever, and bloody diarrhoea. He has recently returned from Egypt. Stool microscopy shows flask-shaped ulcers on colonoscopy and trophozoites. Ultrasound shows a 9 cm liver abscess in the right lobe. What is the most appropriate management?

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Correct answer: A — IV Metronidazole 500 mg TDS plus percutaneous aspiration of the abscess followed by Diloxanide Furoate

Amoebic liver abscess (Entamoeba histolytica) with a large abscess (>5 cm) requires both IV Metronidazole (tissue amoebicide) and percutaneous aspiration/drainage. Aspiration is indicated for large abscesses (>5 cm or >300 mL), risk of rupture, or failure to respond to medical therapy within 5–7 days. After completing Metronidazole, a luminal agent (Diloxanide Furoate 500 mg TDS for 10 days) is essential to eradicate intestinal cysts. Surgical drainage is rarely required.

Reference: WHO 2023 – Amoebiasis guidelines; BNF 2024 – Metronidazole/Diloxanide