Ameobic liver abscess presenting as fever of unknown origin (FUO). Serology, isotope scanning and metronidazole therapy in diagnosis and treatment.

In a study of obscure fevers in Cairo, Egypt, 24 cases of hepatic amoebiasis were diagnosed during a 3-year period from 1977-1980. The counterimmunoelectrophoresis amoebic serologic test was positive in 20 of the 24 patients and was very useful in confirming the diagnosis. The four patients in whom the test was negative had been ill for between 1 and 5 months and had been treated with antibiotics and amoebicidal drugs. Technetium-99 liver scanning localized the site and extent of the abscess and was essential for planning therapy. Treatment with metronidazole and tetracycline resulted in rapid clinical improvement in all except one patient. However, improvement did not indicate cure as our results show: nine patients required needle aspiration of the liver abscess, and seven others had to be referred to surgery for abscess drainage. Large abscesses over 10 cm in diameter should be aspirated to avoid relapse or rupture.