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Amoebic Liver Abscess — RACP Adult Medicine MCQ

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HardInfectious DiseasesAmoebic Liver AbscessRACP Adult Medicine

A 42-year-old has a 9 cm right-lobe amoebic liver abscess. After 72 hours of appropriate nitroimidazole therapy he remains febrile with increasing pain and imaging suggests impending rupture. What is the best next strategy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Continue nitroimidazole, drain percutaneously, then add a luminal amoebicide

Explanation lettering: E = shown as A · D = shown as B · B = shown as D · A = shown as E

C is correct because failure to improve with a threatened lesion is an indication for drainage; nitroimidazole treats invasive trophozoites and a subsequent luminal agent eradicates intestinal carriage. D gets the agents right but postpones source control despite deterioration. E ignores impending rupture and non-response. A reverses the distinct roles of tissue and luminal agents. B is disproportionate when image-guided drainage is feasible. Size alone is not the only decision variable; location, response and rupture risk matter.

Reference: Victorian Department of Health, Amoebiasis: https://www.health.vic.gov.au/infectious-diseases/amoebiasis