A 24-year-old student from Bangladesh presented to the acute medical admission unit with a history of 1 month sweating and loss of appetite. He denied any diarrhoea or loose bowel motion. The patient had pronounced tenderness in the right upper quadrant. It was a diffuse tenderness and guardedness which extended to the right lower intercostal spaces. His temperature spiked only at nights. He had raised white blood cells count and erythrocyte sedimentation rate (ESR). No focus of infection was found initially; however, a computed tomography (CT) scan (fig 1) showed a rounded well defined mass between the left and right lobe which was very superficial. The possible diagnoses were an amoebic liver abscess or a hydatid cyst. Stool examinations did not show ova, cyst or parasite. Serological tests showed positive amoebic IFAT (indirect immunofluorescent antibody test) and a negative hydatid ELISA (enzyme linked immunosorbent assay) test. These findings suggested the diagnosis of amoebic liver abscess.1^,2 The patient was started on oral metronidazole 800 mg three times daily and oral cefalexin 500 mg three times daily for a total of 10 days. A letter was sent to his general practitioner to start him on diloxanide 500 mg three times daily for 10 days.

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Figure 1 Computed tomography scan showing a rounded well defined mass of 6.8 cm in diameter with septations between the left and right lobe.

LEARNING POINTS

• To be aware of amoebic liver disease, especially in overseas patients.

• Amoebic liver abscess does not always follow amoebic dysentery.

• Current trend is to treat amoebic liver abscess medically, and not use drainage unless it is very large or not responding to medical treatment.

• Treatment should include luminal amoebicide (diloxanide) after a course of tissue amoebicide (metronidazole).