30th July 2023

A 45-year-old man returned from India four weeks ago, where he spent two months doing humanitarian work. He presents to A&E with right upper quadrant pain

A 45-year-old man returned from India four weeks ago, where he spent two months doing humanitarian work. He presents to A&E with right upper quadrant pain, a fever, malaise and night sweats. Examination findings include hepatosplenomegaly and tenderness on palpation of the right upper quadrant. There is no jaundice on inspection. An ultrasound scan shows a cystic intrahepatic cavity with features suggestive of an abscess in the posterior aspect of the right lobe.

The gastroenterology team reviews the patient and recommends various serological tests for different conditions that could be considered as differentials. The Entamoeba histolytica IgG enzyme-linked immunosorbent assay (ELISA) comes back positive.

What is the most likely explanation for the patient’s presentation?

Select the SINGLE most appropriate option from the list below. Select ONE option only.