# Amoebic liver abscess co-infected with bacterial liver abscess: A rare case in an immunocompromised patient

## TL;DR

A rare case of a liver abscess caused by both amoebic and bacterial infections in an HIV-positive man is reported, highlighting the importance of advanced diagnostic methods.

## Contribution

The case demonstrates the utility of metagenomic sequencing in diagnosing complex co-infections in immunocompromised patients.

## Key findings

- The patient had a dual infection of amoebic and bacterial liver abscesses.
- Metagenomic sequencing identified Entamoeba histolytica and Salmonella Typhi.
- Combination therapy led to clinical improvement in the patient.

## Abstract

We present a complex case of a 43-year-old HIV-positive Chinese male with co-infection of amoebic liver abscess (ALA) and bacterial liver abscess caused by Salmonella enterica subsp. enterica serotype Typhi (abbreviated as Salmonella Typhi). The patient presented with fever and abdominal pain. Initial bacterial cultures identified Salmonella Typhi, but targeted antibiotic therapy failed to resolve his symptoms, prompting to further investigation. Metagenomic next-generation sequencing (mNGS) of pleural and liver abscess drainage fluids revealed sequences of Entamoeba histolytica, confirming a dual infection. The patient was treated with combination therapy, resulting in clinical improvement. This case highlights diagnostic challenges in immunocompromised patients and underscores the critical role of mNGS in identifying co-infections and guiding treatment. Early recognition and timely intervention are essential for achieving optimal outcomes in such complex cases.