A 24-year-old man from rural Bihar has 2 weeks of fever, night sweats, and dull right upper quadrant pain. Ultrasound shows a single 9 cm abscess in the right lobe. Aspirated pus resembles anchovy sauce, and Entamoeba histolytica serology is strongly positive. He is haemodynamically stable. The most appropriate initial management is:

• A Laparoscopic deroofing and omental packing
• B Percutaneous catheter drainage with intravenous antibiotics
• C Open surgical drainage through a subcostal incision
• D Metronidazole therapy alone ✓

Explanation

Anchovy sauce pus with positive amoebic serology confirms amoebic liver abscess, which responds to metronidazole in over 90 percent of cases without drainage. Aspiration is reserved for failure to respond after several days of therapy, a left lobe abscess threatening pericardial rupture, very large abscesses, or imminent perforation. Pyogenic abscess, unlike amoebic, usually needs drainage alongside antibiotics.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.