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Amebic Liver Abscess Following Metronidazole Therapy for Amebic Colitis

A 21-year-old white male serviceman developed amebic dysentery in Vietnam which was cured clinically and parasitologically with metronidazole, 750 mg three times a day for 10 days. Eight months later (2 months after his return to the United States) he was hospitalized with fever and right upper quadrant pain and tenderness. A large hepatic abscess was detected on scan. Precystic forms of amebae were present in aspirates of the abscess. Cultures for bacteria and fungi were negative. Multiple stool specimens were negative for cysts or trophozoites of Entamoeba histolytica. Clinical cure with slow disappearance of the filling defect on liver scan followed chloroquine and uncomplicated prolonged metronidazole therapy. It is postulated that the liver abscess was present at the time of original infection and that the initial course of metronidazole therapy, though appropriate for colonic amebiasis, was not adequate for amebic hepatic abscess. It is recommended that liver function tests and radioisotopic scan of the liver be obtained in all cases of colonic amebiasis to detect early evidence of hepatic amebiasis.

Accepted for publication October 13, 1973.