Huge and Ruptured Amoebic Liver Abscess Diagnosed by Metagenomic Next-Generation Sequencing

Abstract

A 46-year-old white man, presented to the emergency department with backache for 2 weeks, which aggravated with right upper abdominal pain for 1 day without fever. He was homosexual with normal dietary habits and no history of alcoholism or smoking. Contrast-enhanced CT showed a huge mass with several smaller masses underneath occupying the right lobe of liver, with large amount of abdominal and pelvic effusion. The huge liver abscess was punctured under the guidance of bedside ultrasound, and the punctured fluid was also like “anchovy sauce” (a total of 2620ml). The mNGS of the pus near the wall of the abscess cavity showed Entamoeba histolytica. An amoebic liver abscess was diagnosed. The patient’s condition was stable after metronidazole administration and drainage of pus. He was hospitalized in the ICU for 18 days and for another 24 days in the general ward of the hospital. The results obtained in this case highlights that the use of mNGS for rapid diagnosis of huge and ruptured amebic liver abscess in non-endemic areas without capability of serologic tests.