Intestinal and hepatic amoebiasis in a sailor

A 47 year old sailor presented with a short history of diarrhoea, fever and weight loss. Crohn's disease and simple liver cysts had been diagnosed a week earlier in Brazil. Endoscopy demonstrated discrete ulcers in the colon, and CT scan showed multiple liver abscesses. He was started on metronidazole and cefotaxime, but the fever failed to respond until the abscesses were drained. No pathogens were isolated in stool, liver aspirate or blood culture. Histopathological examination of colonic biopsies performed at this hospital showed only inflammatory changes, but the original slides obtained from South America showed clear evidence of amoebiasis. Serological tests were positive for amoebiasis, and a course of diloxanide was prescribed following treatment with metronidazole. The patient made a good recovery. If there is a history of travel to endemic areas, a high degree of suspicion and pursuit of the diagnosis are important when intestinal and/or extraintestinal Entamoeba histolytica infection is suspected. This condition responds well to appropriate drugs.