A 35-year-old man from rural Bihar presents with fever, right upper quadrant pain, and tender hepatomegaly. Ultrasound shows a solitary 6 cm hypoechoic lesion in the right lobe. Aspiration yields thick brownish fluid resembling anchovy paste. The most appropriate first-line treatment is:

• A Albendazole for 6 weeks
• B Surgical drainage with omentoplasty
• C Broad-spectrum antibiotics and percutaneous pigtail drainage
• D Metronidazole alone ✓

Explanation

Anchovy paste pus with a solitary right lobe lesion is diagnostic of amoebic liver abscess caused by Entamoeba histolytica. Uncomplicated cases respond to metronidazole in over 90 percent of patients, with aspiration reserved for failure to respond, huge abscesses, left lobe location threatening pericardial rupture, or diagnostic uncertainty. Pigtail drainage with antibiotics is the approach for pyogenic abscesses.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.