A 35-year-old man from rural India has a 9 cm amoebic liver abscess in the right lobe confirmed on ultrasound, with fever and tender hepatomegaly but no peritonism. He is haemodynamically stable. The most appropriate initial treatment is:
- A Metronidazole alone with clinical monitoring ✓
- B Immediate surgical drainage via laparotomy
- C Percutaneous catheter drainage before starting drugs
- D Chloroquine as monotherapy
Correct answer: A. Metronidazole alone with clinical monitoring
Explanation
Uncomplicated amoebic liver abscess responds to metronidazole in over 90 percent of cases, with defervescence expected within 3 to 4 days, so drugs alone are the standard first step. Aspiration or catheter drainage is reserved for failure of medical therapy after several days, very large abscesses, left lobe abscesses at risk of pericardial rupture, or impending rupture. Laparotomy is needed only for free rupture with peritonitis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.