Because we were concerned about abscess rupture, we placed percutaneous drainage catheters, with CT guidance, in the five largest lesions (Figure 2). Results of polymerase www.selleckchem.com/products/crenolanib-cp-868596.html chain reaction testing for Entamoeba histolytica were positive in three different samples, establishing the diagnosis of extraintestinal amebiasis. Figure 2 Distribution of five drainage catheters as shown on maximum intensity projection at day 10. All catheters were removed after this CT scan because drainage had stopped. We started oral metronidazole therapy and stopped the piperacillin�Ctazobactam treatment. Our patient��s fever and elevated inflammation markers resolved, and we removed the drains. Within 30 days, he was discharged from hospital. The metronidazole was continued, and paromomycin was given intraluminally for 10 days.

Fifteen months after treatment, the patient was in good health. Discussion Amebiasis is a common disease in developing countries and the second-leading cause of death from parasitic disease worldwide. However, only 4%�C10% of infected people have symptomatic disease, mostly amebic colitis.1,2 Less than 1% of infections lead to extraintestinal manifestations, of which amebic liver abscess is the most common.1 Untreated, amebic liver abscesses are almost always fatal; however, with timely diagnosis and treatment, mortality is as low as 1%�C3%.2 Most individuals are infected via fecal�Coral transmission, when insufficient hygienic conditions lead to contamination of food or water. Less often, the infection is transmitted sexually by direct anal�Coral contact with an infected individual.

In countries where the disease is not endemic, amebic abscesses are seen mostly in travellers or immigrants from developing countries.1,2 Liver abscesses generally take several weeks to develop. Infected travellers returning from regions where amebiasis is endemic usually present with symptoms of amebic abscesses within 8 to 20 weeks (median 12 weeks) after their return. A later onset, even after years, has been described.2 Of potential relevance to our case is the growing number of patients with invasive amebiasis related to anal�Coral sexual activity, especially between same-sex partners.3 According to population surveys in developed countries, direct anal�Coral sexual contact takes place on a regular basis among 5.5% of men and 3.3% of women.

4 Among those with bisexual and homosexual activity, the percentage can rise up to 46%,5 which explains a higher risk of infection with E. histolytica in this group regardless of their travel history. Diagnosis Entinostat The most common symptoms of amebic liver abscesses are fever and abdominal pain in the right upper quadrant; hepatic tenderness may be found on examination.1,2,6 Concomitant gastrointestinal symptoms are present in 10%�C35% of patients.1 The onset of symptoms is usually acute but can also have a more chronic course.