# An Imported Case of Gigantic Amoebic Liver Abscess in a 24-Year-Old Woman in Singapore

## TL;DR

A 24-year-old woman in Singapore had a rare 21 cm amoebic liver abscess, highlighting the challenges in diagnosing such cases in developed countries.

## Contribution

This case report emphasizes the diagnostic challenges of large amoebic liver abscesses in non-endemic regions.

## Key findings

- The patient had a 21 cm amoebic liver abscess, an unusually large size for this condition.
- The case illustrates the difficulty in differentiating amoebic from pyogenic liver abscesses.
- Early diagnosis and treatment are critical to prevent complications and mortality.

## Abstract

A liver abscess can be due to several different microbiological aetiologies. While pyogenic liver abscess is most frequently encountered, amoebic liver abscess and hydatid cyst caused by the parasites, Entamoeba histolytica and Echinococcus granulosus, respectively, should be considered whenever there is epidemiological exposure. As parasitic infections are now rarely seen in clinical practice in developed countries with improvement in sanitation, lack of clinical experience in managing amoebic liver abscesses and overlapping clinical and imaging features between amoebic and pyogenic liver abscesses may lead to delay in diagnosis. In particular, although amoebic liver abscesses respond well to treatment if diagnosed early, they can progress and rupture with high mortality if treatment is delayed. Hence, early diagnosis and prompt initiation of antimicrobials are crucial to prevent complications and death. This case report highlights a case of a very large 21 cm ALA in a young lady to illustrate the challenges faced during diagnostic evaluation.