BACKGROUND
Amebiasis is a
parasitic infection caused by the protozoan Entamoeba histolytica. Amebic
brain abscesses are a rare form of invasive
amebiasis frequently lethal due to the difficulty of its diagnosis and inadequate treatment. Cerebral
amebiasis poses a therapeutic challenge as evidenced by the scarcity of papers reporting complete recovering
after treatment. CASE REPORT We report the case of a 39-year-old Spanish man, with a history of alcohol and
drug abuse. He had never traveled outside of Europe, no reported oral-anal sexual contact, and no history of
immunosuppressant medication. He was admitted to the Emergency department with temperature of 38°C,
abdominal pain, and
diarrhea. An abdominal CT scan showed multiples
abscesses in the liver. Therefore, empirical
meropenem treatment was started on suspicion of
pyogenic liver abscesses due to lack of epidemiological risk factors for
parasitic infection. In the liver aspirate samples, E. histolytica trophozoites were directly visualized and a real-time PCR was also positive for it. After
amebiasis diagnosis, intravenous (IV)
metronidazole therapy was initiated. During his admission, the patient developed pulmonary, cutaneous and cerebral involvement
amebiasis. The management of amebic
brain abscesses includes surgical drainage and
antiparasitic treatment, in our case IV
metronidazole was maintained for 10 weeks. No surgical treatment was performed and even so, the patient evolved favorably. CONCLUSIONS Amebic
brain abscesses have a high mortality rate if inadequate treatment. A timely diagnosis and suitable treat can reduce its mortality, so the diagnosis of amebic
infection should not be precluded in non-endemic countries.