Amoebic Liver Abscess Research Articles

Amoebic liver abscess in an adult Nigerian: A case report

Background: Amoebic liver abscess (ALA) is a parasitic infection caused by Entamoeba histolytica. ALA is a significant health concern, particularly in regions with poor sanitation and hygiene practices. Radiological imaging plays a crucial role in the diagnosis and management of ALA. Methods: We present a case report of a 40-year-old male patient with ALA. The patient presented to a radio diagnostic centre in Umuahia with right upper quadrant abdominal pain, fever,diarrhea and weight loss. Radiological evaluation was performed using abdominal ultrasound and contrast-enhanced CT scan. The imaging findings were correlated with clinical presentation and laboratory investigations. Results: The radiological findings revealed a focal hypoechoic lesion in the right hepatic lobe with ill-defined margins and internal echoes suggestive of liquefaction. The contrast-enhanced CT scan confirmed the presence of a well-defined, hypodense lesion with peripheral enhancement and central hypoattenuation. No evidence of biliary ductal dilatation or vascular invasion was observed. Based on the findings, a diagnosis of ALA was made, and the patient was initiated on intravenous metronidazole therapy. Follow-up imaging demonstrated a decrease in abscess size and resolution of internal echoes, indicating a positive response to treatment. Conclusion: Radiological imaging, including ultrasound and CT scan, plays a pivotal role in the diagnosis and management of ALA. The characteristic imaging findings, such as hypoechoic lesions with internal echoes and peripheral enhancement with central hypoattenuation, aid in differentiating ALA from other hepatic lesions. Early diagnosis and prompt initiation of appropriate therapy are crucial for favorable patient outcomes. Radiological follow-up allows monitoring of treatment response and guides further management decisions.

Enteropathogenic Escherichia coli modulates the virulence and pathogenicity of Entamoeba dispar

Amoebiasis is a disease caused by Entamoeba histolytica, affecting the large intestine of humans and occasionally leading to extra-intestinal lesions. Entamoeba dispar is another amoeba species considered commensal, although it has been identified in patients presenting with dysenteric and nondysenteric colitis, as well as amoebic liver abscess. Amoebic virulence factors are essential for the invasion and development of lesions. There is evidence showing that the association of enterobacteria with trophozoites contributes to increased gene expression of amoebic virulence factors. Enteropathogenic Escherichia coli is an important bacterium causing diarrhea, with high incidence rates in the world population, allowing it to interact with Entamoeba sp. in the same host. In this context, this study aims to evaluate the influence of enteropathogenic Escherichia coli on ACFN and ADO Entamoeba dispar strains by quantifying the gene expression of virulence factors, including galactose/N-acetyl-D-galactosamine-binding lectin, cysteine proteinase 2, and amoebapores A and C. Additionally, the study assesses the progression and morphological aspect of amoebic liver abscess and the profile of inflammatory cells. Our results demonstrated that the interaction between EPEC and ACFN Entamoeba dispar strains was able to increase the gene expression of virulence factors, as well as the lesion area and the activity of the inflammatory infiltrate. However, the association with the ADO strain did not influence the gene expression of virulence factors. Together, our findings indicate that the interaction between EPEC, ACFN, and ADO Entamoeba dispar strains resulted in differences in vitro and in vivo gene expression of Gal/GalNAc-binding lectin and CP2, in enzymatic activities of MPO, NAG, and EPO, and consequently, in the ability to cause lesions.

Amebic liver abscess: An update.

Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.

Epidemiology and factors associated with amoebic liver abscess at a tertiary care hospital in Northern India

Liver abscess is a collection of purulent material in the liver most commonly seen in the tropical countries. It can sometimes lead to significant morbidity and mortality if not treated timely and adequately. Through this study we wish to put light upon the current status of clinical aspects, laboratory features, and outcomes of liver abscess. The study was conducted at a tertiary care hospital in Northern India in the period of August 2020 to July 2021. All patients diagnosed with liver abscess of size >5 cm or left lobe liver abscess of any size were included in the study. All relevant laboratory investigations were conducted. The outcomes were noted and data was entered in MS Excel sheet. Analysis was done using SPSS version 26. Sixty-three patients were included in the study. A male predominance was noted. Mean age at presentation was 37.8 years. Most patients were part of the lower socioeconomic class. Pain abdomen and fever were the most common presenting symptoms. Amoebic liver abscess was much more frequently seen than pyogenic liver abscess. Deranged coagulation profile was seen in 88.9% patients. 85.7% patients were amenable to treatment with minimal intervention. Mortality as an outcome was seen in 9.5% patients Significant correlation was found between various laboratory parameters and outcomes such as length of hospital stay and mortality. Early diagnosis and treatment is crucial in management of patients with liver abscess even today.

The Effect of Contrast-enhanced Ultrasound via Vessels and Surgical Drains Guidance Percutaneous Catheter Drainage in the Treatment of Pyogenic Liver Abscess.

Pyogenic liver abscess (PLA) is a purulent disease caused by microbial contamination of liver parenchyma and includes amoebic liver abscess, fungal liver abscess, and the most common bacterial liver abscess. Explore the efficacy of contrast-enhanced ultrasound (CEUS) via vessels and surgical drain guidance percutaneous catheter drainage (PCD) in the treatment of pyogenic liver abscesses (PLA). A total of 86 PLA patients who underwent PCD treatment in our hospital from May 2018 to February 2023 were retrospectively selected. Of them, 41 patients were treated under intravenous CEUS guidance (Control group), and 45 patients were treated under CEUS via vessels and surgical drain guidance (study group). Perioperative characteristics, treatment effectiveness, and incidence of complications were analyzed and compared between groups. The duration of surgery, drainage, white blood cell recovery, body temperature recovery, and hospitalization in the study group were longer than those in the control group (P<0.05). The total effective rate of the study group (95.56%) was higher than that of the control group (80.49%) (P<0.05). The incidence of complications in the study group (4.44%) was lower than that in the control group (19.51%) (P<0.05). Compared with intravenous CEUS alone, treatment under CEUS via vessels and surgical drains-guided PCD was associated with shorter surgical time, faster recovery, better treatment effect, lower risk of complications, and ensured treatment safety in PLA patients.

Amoebic Liver Abscess: Potential Application of New Diagnostic Techniques for an Old Pathogen.

Amoebic liver abscess is a severe and potentially life-threatening infection requiring prompt diagnosis and early targeted treatment. Diagnosis is challenging because conventional diagnostic methods such as light microscopy and serology are often unreliable. Molecular techniques have emerged as an additional diagnostic tool, suddenly becoming the new diagnostic reference standard. More recently, commercial multiplex PCR panels, including FilmArray, have been introduced, which permit the simultaneous detection of several enteric pathogens including Entamoeba histolytica in stool samples. We report a case of an amoebic liver abscess promptly diagnosed by FilmArray gastrointestinal panel performed on liver drainage fluid.

Revisiting the isolation and characterisation of Entamoeba histolytica lipopeptidophosphoglycan

The parasite Entamoeba histolytica is the cause of amoebic dysentery and liver abscess in humans. On the protozoan cell surface, a variety of glycosylated molecules are involved in the interaction with the environment, such as attachment to the colonic mucus. One of these molecules is the lipopeptidophosphoglycan (LPPG), a complex surface component with antigenic properties. Its structure is only partly known, it is a glycosylphosphatidylinositol (GPI)-linked glycoprotein with a large amount of O-glycosylation. To date, the sequence of a core protein has not been identified. In this study, we further investigated this complex surface molecule aided by the availability of the monoclonal antibody EH5, which had been raised in our laboratory. We studied the extraction of LPPG in various solvent mixtures and discovered that 2-butanol saturated water was simple and superior to other solvents used in the past. The isolated LPPG was subjected to treatment with several proteases and the Ser/Thr specific cleavage agent scandium (III) trifluoromethanesulfonate (scandium triflate). The products were probed with antibody EH5 and the blots showed that the LPPG preparation was largely resistant to standard proteases, but could be cleaved by the scandium compound. These observations could point to the existence of a Ser- or Thr-rich core protein structure.

Multi-locus sequence analysis reveals phylogenetically segregated Entamoeba histolytica population.

Amoebiasis, caused by the enteric parasite, Entamoeba histolytica, is one of the major food- and water-borne parasitic diseases in developing countries with improper sanitation and poor hygiene. Infection with E. histolytica has diverse disease outcomes, which are determined by the genetic diversity of the infecting strains. Comparative genetic analysis of infecting E. histolytica strains associated with differential disease outcomes from different geographical regions of the world is important to identify the specific genetic patterns of the pathogen that trigger certain disease outcomes of Amoebiasis. The strategy is able to elucidate the genealogical relation and population structure of infecting E. histolytica strains from different geographical regions. In the present study, we have performed a comparative genetic analysis of circulating E. histolytica strains identified from different parts of the world, including our study region, based on five tRNA-linked short tandem repeat (STR) loci (i.e., D-A, NK2, R-R, STGA-D and A-L) and evaluated their potential associations with differential disease outcomes of Amoebiasis. A number of regional-specific, emerging haplotypes of E. histolytica, significantly associated with specific disease outcomes have been identified. Haplotypes, which have a significant positive association with asymptomatic and amoebic liver abscess outcomes, showed a significant negative association with diarrheal outcome, or vice versa. Comparative multi-locus analysis revealed that E. histolytica isolates from our study region are phylogenetically segregated from the isolates of other geographical regions. This study provides a crucial overview of the population structure and emerging pattern of the enteric parasite, E. histolytica.

Practical approach to a patient with fever who travelled to the tropics.

By 2030, an estimated 2 billion international tourist trips are expected annually worldwide, with citizens of Poland as important contributors. Illness rates among returnees from developing regions range between 43% and 79%. Properly diagnosing fever in these travelers is vital due to potentially serious implications. After visiting tropical and subtropical zones, the main health complaints are diarrhea, fever, and skin lesions. A reliable diagnosis begins with taking a comprehensive travel history and identifying potential risks. In travelers returning from sub‑Saharan Africa, malaria caused by Plasmodium falciparum is the main cause of fever, affecting 50 in every 1000 cases. Among returnees from Southeast Asia, dengue is dominant, occurring in 50-60 per 1000 cases, and its prevalence rises significantly nowadays. Other significant diseases include chikungunya, Zika, typhoid fever, amebic liver abscess, and occasionally viral hemorrhagic fevers. SARS‑CoV‑2 and influenza viruses are crucial pathogens as well. An in‑depth assessment of the travel history, combined with knowledge on tropical diseases, are key to the diagnostic process, and algorithms may be helpful in selecting appropriate tests and treatment methods.

Amoebic colitis and liver abscess: A rare case of autochthonous invasive infection due to Entamoeba histolytica

We report an unusual and confirmed case of invasive amebiasis in a non-endemic area where the source of infection remains unknown. During her admission, the patient developed amebic colitis and extraintestinal liver abscess with a favorable outcome following the antiparasitic therapy.

Comparative Incidence of Pyogenic and Amoebic Liver Abscesses in Trauma and Emergency Patients at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna: A One-Year Observational Study.

Liver abscesses, particularly pyogenic and amoebic types, pose a significant healthcare challenge, especially in developing countries. Accurate differentiation and effective treatment of these abscess types are crucial in emergency medical settings. This study aims to analyze the incidence, clinical characteristics, and treatment outcomes of pyogenic and amoebic liver abscesses in a trauma and emergency department setting. Conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, this one-year observational study involved 100 patients diagnosed with liver abscesses. The study employed a comprehensive approach, examining incidence rates, demographic trends, clinical presentations, treatment modalities, and outcomes, including recurrence rates. The study observed a higher incidence of pyogenic liver abscesses, accounting for 60% of cases (n=60), compared to amoebic liver abscesses, which constituted 40% (n=40). In terms of demographics, pyogenic liver abscesses were more prevalent among older males, with the average age being 48 years, and 70% (n=42) of the patients were male. In contrast, amoebic liver abscess patients had an average age of 42 years, with 60% (n=24) being male. Key clinical findings revealed that pyogenic liver abscess cases (n=60) had higher white blood cell counts and elevated liver enzyme levels than those with amoebic liver abscesses (n=40). The treatment outcomes indicated high success rates for both types of liver abscesses. Pyogenic liver abscesses had a success rate of 90% (n=54), while amoebic liver abscesses showed a slightly higher success rate at 95% (n=38). However, there was a notable difference in recurrence rates: pyogenic liver abscesses had a recurrence rate of 8.3% (n=5), whereas amoebic liver abscesses had a lower recurrence rate of 2.5% (n=1). The logistic regression analysis conducted to identify potential predictors of treatment success did not reveal any statistically significant factors across both types of liver abscesses. The study highlights a higher incidence of pyogenic liver abscesses in an urban Indian healthcare setting and the complexity of predicting treatment outcomes based on demographic and clinical factors. The findings emphasize the need for nuanced clinical approaches and vigilant post-treatment monitoring, especially for pyogenic liver abscesses. They also underscore the importance of further research to explore additional variables influencing liver abscess treatment outcomes.

Clinical Profile in Patients of Amoebic Liver Abscess with and without Hyperbilirubinemia: A Prospective Cohort Study

Introduction: In tropical countries like India, two-thirds of liver abscess cases are amoebic. Along with abdominal pain, fever, and other non-specific clinical features, jaundice is commonly observed in Amoebic Liver Abscess (ALA) cases. However, the understanding of jaundice in a patients with ALA is limited, and it is associated with a poor prognosis. Aim: To compare the morbidity and mortality of ALA patients with and without hyperbilirubinemia, as well as their clinical outcomes. Materials and Methods: The present prospective cohort study was conducted at a tertiary teaching institute in northern India. It included 150 patients aged between 20 and 60 years with a confirmed diagnosis of ALA. The patients were divided into two groups based on the presence or absence of hyperbilirubinemia. Those with jaundice resulting from other causes or a history of hepatitis were excluded. Variables examined in the study included age, sex, alcohol intake, basic laboratory parameters, ultrasound-assessed abscess size and number, and duration of hospital stay. Results: Among the 150 cases, 22 (14.6%) had elevated serum bilirubin levels (&gt;1 mg/dL). Additionally, 122 (81.33%) had a history of alcohol intake, and 117 (78%) had a single abscess cavity. In ALA patients with hyperbilirubinemia, 12 (54.55%) had abnormal creatinine values, and 6 (27.26%) experienced complications such as rupture and peritonitis. One mortality occurred in a patient with ALA and jaundice. Conclusion: ALA patients with jaundice exhibited larger abscess cavities, a higher complication rates, a longer hospital stays, and a poor prognoses.

Genes differentially expressed between pathogenic and non-pathogenic Entamoeba histolytica clones influence pathogenicity-associated phenotypes by multiple mechanisms.

Recently, two genes involved in amoebic liver abscess formation in a mouse model were identified by their differential expression of non-pathogenic (A1np) and pathogenic (B2p) clones of the Entamoeba histolytica isolate HM:1-IMSS. While overexpression of a gene encoding the metallopeptidase EhMP8-2 reduces the virulence of the pathogenic clone B2p, overexpression of the gene ehi_127670 (ehhp127), encoding a hypothetical protein, increases the virulence of the non-pathogenic clone A1np, while silencing this gene in the pathogenic B2p reduces virulence. To understand the role of both molecules in determining the pathogenicity of E. histolytica, silencing, and overexpression transfectants were characterized in detail. Silencing of ehmp8-2, of the homologous gene ehmp8-1, or both in non-pathogenic A1np trophozoites significantly altered the transcript levels of 347, 216, and 58 genes, respectively. This strong change in the expression profiles caused by the silencing of ehmp8-1 and ehmp8-2 implies that these peptidases regulate the expression of numerous genes. Consequently, numerous phenotypic characteristics, including cytopathic, hemolytic, and cysteine peptidase activity, were altered in response to their silencing. Silencing of ehhp127 in pathogenic B2p trophozoites did not affect the expression of other genes, whereas its overexpression in non-pathogenic A1np trophozoites results in an altered expression of approximately 140 genes. EhHP127 is important for trophozoite motility, as its silencing reduces, while its overexpression enhances movement activity. Interestingly, the specific silencing of ehhp127 also significantly affects cytopathic, cysteine peptidase, and hemolytic activities. All three molecules characterized in this study, namely EhMP8-1, EhMP8-2, and EhHP127, are present in amoeba vesicles. The results show that ehmp8-2 and ehhp127 are not only differentially expressed between pathogenic and non-pathogenic amoebae, but that they also significantly affect amoeba pathogenicity-associated phenotypes by completely different mechanisms. This observation suggests that the regulation of amoeba pathogenicity is achieved by a complex network of molecular mechanisms rather than by single factors.

Current Management of Liver Abscess: A Narrative Review

Liver abscess can be divided into pyogenic and amoebic liver abscess. The common organisms that cause pyogenic liver abscess include Escherichia Coli, with amoebic liver abscess being caused by Entamoeba histolytica. The diagnosis is made by ultrasound, computerized tomography, and magnetic resonance imaging of the liver. The treatment can be divided into medical therapy which involves percutaneous drainage and intravenous antibiotics, and surgical therapy which includes surgical drainage either by open or laparoscopic surgery. Surgical drainage is indicated for patients who have failed medical therapy. We have conducted this review article to look at the current management of liver abscess with regards to the role of percutaneous drainage and surgical drainage.

Novel diagnostic approach for amoebic liver abscess using cell free (cf) DNA: a prospective study

Background Amoebic liver abscess (ALA) is commonly seen in tropical countries and diagnosis of ALA relies mainly on non-specific serological and imaging techniques as well as PCR from pus. Objective This study evaluated the potential of using cell free DNA (cfDNA) from serum and urine for diagnosing ALA. Methods We prospectively evaluated quantitative PCR (qPCR) for detection of cf DNA in serum and urine sample in all liver abscess patients. The samples were collected from patients reporting to emergency ward of Postgraduate Institute of Medical Education and Research, Chandigarh, India with symptoms suggestive of liver abscess. Real time PCR was done to detect cf DNA in serum and urine by targeting 99-bp unit of small subunit rRNA of Entamoeba histolytica and conventional PCR for pus. Results A total 113 samples (serum and urine) and 100 pus samples were analysed. A total of 62 ALA patients were confirmed; with maximum 57 patients detected by qPCR for cfDNA in the serum, 55 patients by PCR on pus aspirate and 50 ALA patients by qPCR for cfDNA in urine sample. Therefore, the sensitivity of qPCR for detection of cf DNA in serum was 91.94% and for urine was 80.65%. Conclusion A total of 11.2% of ALA patients were diagnosed only through detection of E. histolytica cf DNA in their serum and urine. Detection of cfDNA from serum, urine of ALA has a potential role in future especially for developing countries as it is a rapid, sensitive and patient friendly diagnostic approach.

Real-time loop-mediated isothermal amplification (real-time LAMP) assay for rapid diagnosis of amoebic liver abscess.

Among the parasitic diseases, amoebic liver abscess (ALA) ranks second to malaria in terms of mortality. Due to the poor sensitivity of conventional diagnostic methods, there is a need for the development of effective and rapid diagnostic methods for ALA. Thus, the purpose of this work was to develop a real-time loop-mediated isothermal amplification (RT-LAMP) assay specific to Entamoeba histolytica. Further, we compared the performance of real-time LAMP with conventional and real-time PCR (RT-PCR) targeting 18S small subunit ribosomal RNA (18S SSU rRNA) gene of E. histolytica in patients with ALA. A total of 126 liver samples were obtained for the study. Of these, 96 aspirated pus samples were obtained from patients suffering from an ALA (serology confirmed, anti-amoebic immunoglobulin IgG positive), 19 aspirated pus samples from patients with pyogenic liver abscess (PLA, 16S RNA gene positive) and 11 autopsy liver tissues. The results showed that the DNA of E. histolytica was detected in 81 samples by conventional PCR, 93 by RT-PCR and 95 by RT-LAMP. The analytical sensitivity of the RT-LAMP assay was much higher than the other two techniques. RT-LAMP assay was able to amplify up to one copy of the targeted gene of E. histolytica while conventional PCR and RT-PCR could amplify up to 103 and 102 copies of the targeted gene of E. histolytica, respectively. In conclusion, RT-LAMP proved to be a sensitive, specific and rapid test which can be utilised as an effective tool for the diagnosis of ALA.

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ ВНЕКИШЕЧНОГО АМЕБИАЗА С РАЗВИТИЕМ АБСЦЕССА ПРАВОЙ ДОЛИ ПЕЧЕНИ

Background. Due to the polymorphism, low prevalence in RB and in turn the difficulty of diagnosis, the treatment of extraintestinal amoebiasis is an important issue of surgery. Objective. To demonstrate the results of surgical treatment of a patient with amebic liver abscess. Material and methods. The article presents its own clinical observation of the surgical treatment of amebic liver abscess. The patient underwent drainage of the right liver lobe abscess under the laparoscopic control according to the method developed in the clinic. Results. The patient was discharged in satisfactory condition for further out-patient follow-up by the surgeon and infectious disease doctor at the place of residence. There were no repeated appeals and admissions. Conclusions. Clinical observation indicates the need for combined treatment of amoebic liver abscesses using external drainage in combination with conservative therapy, including the use of broad-spectrum antibiotics and metronidazole.

Involvement of NOX2-derived ROS in human hepatoma HepG2 cell death induced by Entamoeba histolytica.

Entamoeba histolytica is an enteric tissue-invasive protozoan parasite causing amoebic colitis and liver abscesses in humans. Amoebic contact with host cells activates intracellular signaling pathways that lead to host cell death via generation of caspase-3, calpain, Ca2+ elevation, and reactive oxygen species (ROS). We previously reported that various NADPH oxidases (NOXs) are responsible for ROS-dependent death of various host cells induced by amoeba. In the present study, we investigated the specific NOX isoform involved in ROS-dependent death of hepatocytes induced by amoebas. Co-incubation of hepatoma HepG2 cells with live amoebic trophozoites resulted in remarkably increased DNA fragmentation compared to cells incubated with medium alone. HepG2 cells that adhered to amoebic trophozoites showed strong dichlorodihydrofluorescein diacetate (DCF-DA) fluorescence, suggesting intracellular ROS accumulation within host cells stimulated by amoebic trophozoites. Pretreatment of HepG2 cells with the general NOX inhibitor DPI or NOX2-specific inhibitor GSK 2795039 reduced Entamoeba-induced ROS generation. Similarly, Entamoeba-induced LDH release from HepG2 cells was effectively inhibited by pretreatment with DPI or GSK 2795039. In NOX2-silenced HepG2 cells, Entamoeba-induced LDH release was also significantly inhibited compared with controls. Taken together, the results support an important role of NOX2-derived ROS in hepatocyte death induced by E. histolytica.

Recurrent amebic liver abscesses despite metronidazole treatment: A rare case report

Key Clinical MessageAmebic liver abscesses should be considered in adult males with a liver abscess and a history of travel to endemic areas. Effective treatment includes metronidazole, followed by paromomycin.

Preoperative Transcatheter Arterial Embolization for Spontaneous Rupture of Huge Amebic Liver Abscess with Massive Intraperitoneal Hemorrhage

An 18-year-old male developed a huge liver abscess with severe anemia over the course of 2 weeks. Abdominal contrast enhanced computed tomography showed ruptured huge liver abscess in the right liver lobe with signs of active hemorrhage (contrast extravasation). Serology examination confirmed amoeba as the suspected pathogen of cause. Angiography was performed followed by transcatheter arterial embolization to localize and control the hemorrhage. Embolization using a combination of polyvinyl alcohol and gelfoam successfully controlled the active hemorrhage. Exploratory laparotomy was performed to evacuate and debride the huge abscess. Metronidazole was given and showed good results. Huge liver abscess size is a predictor of conservative management failure and requires a gradual step-up intervention. The purpose of this paper is to explain the importance of imaging in detecting liver abscess and active hemorrhage along with the role of interventional radiology in this case.