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Anchovy Sauce Amoebic Abscess — SCE Infectious Diseases MCQ

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EasyTropical & Imported InfectionsAnchovy Sauce Amoebic AbscessSCE Infectious Diseases

A 45-year-old man develops a liver abscess. CT-guided aspiration reveals 'anchovy sauce' pus. He has no travel history but lived in rural Mexico for 10 years before moving to the UK 3 years ago. Entamoeba histolytica serology is strongly positive. What does the 'anchovy sauce' appearance indicate?

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Correct answer: B — Amoebic liver abscess — the chocolate/anchovy sauce appearance is necrotic hepatocytes and blood (NOT pus with bacteria); E. histolytica causes tissue lysis without typical pyogenic suppuration

'Anchovy sauce' or 'chocolate sauce' aspirate from a liver abscess is classic for amoebic abscess (E. histolytica). The reddish-brown colour is from necrotic hepatocytes and old blood — NOT bacterial pus. Amoebic trophozoites are found at the abscess margin, not in the centre. Treatment: Metronidazole 800 mg TDS for 5–10 days (tissue amoebicide) plus Diloxanide Furoate (luminal agent to clear cysts). Aspiration is needed for: large abscesses (>5 cm or >300 mL), failure to respond to medical therapy (within 5–7 days), or rupture risk.

Reference: WHO 2023 – Amoebiasis; BNF 2024 – Metronidazole