A 30-year-old man from Bihar presents with fever, right upper quadrant pain, and tender hepatomegaly. Ultrasound shows a solitary 7 cm abscess in the right lobe. Aspiration yields thick brown fluid without odor. He is hemodynamically stable. What is the most appropriate initial treatment?
- A Surgical deroofing of the abscess
- B Percutaneous catheter drainage plus piperacillin-tazobactam
- C Metronidazole alone ✓
- D Albendazole plus aspiration
Correct answer: C. Metronidazole alone
Explanation
The anchovy sauce aspirate and solitary right lobe lesion are classic for amebic liver abscess caused by Entamoeba histolytica. Uncomplicated cases respond to metronidazole alone, with aspiration reserved for failure to respond, left lobe abscesses threatening pericardial rupture, or very large lesions. Pyogenic abscesses require antibiotics with drainage, which would be the trap if the aspirate were frank pus. Albendazole treats hydatid disease, not amebiasis.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.