A case of giant amebic liver abscess persisting for years after treatment.

Abstract

A 64-year-old male was admitted with a giant liver abscess five days after the onset of fever. Upon admission, he received intravenous antibiotics, including metronidazole (MNZ), and underwent percutaneous liver abscess drainage. Despite early intervention, he developed severe respiratory failure requiring mechanical ventilation, and the abscess rapidly enlarged to 15.1 cm in diameter by clinical day 9. His general condition and systemic inflammation improved after four weeks of antibiotic therapy with MNZ, meropenem, and daptomycin. Entamoeba histolytica was later identified by PCR in the drained fluid, confirming the diagnosis of amebic liver abscess (ALA). However, liver lesion has remained large over several years. Follow-up CT showed the abscess measured 13.0 cm at 1 year and 9.2 cm at 3 years post-treatment. This case highlights a remarkably rare presentation of ALA in which a giant liver lesion had not disappeared for years despite appropriate treatment, underscoring the need for caution in cases of severe ALA with fulminant progression.