A case of giant amebic liver abscess persisting for years after treatment

A 64-year-old male was admitted with a giant liver abscess 5 days after the onset of fever. Upon admission, he received intravenous antibiotics, including metronidazole (MNZ), and underwent percutaneous liver abscess drainage. Despite early intervention, he developed severe respiratory failure requiring mechanical ventilation, and the abscess rapidly enlarged to 15.1 cm in diameter by clinical day 9. His general condition and systemic inflammation improved after 4 weeks of antibiotic therapy with MNZ, meropenem, and daptomycin. Entamoeba histolytica was later identified by polymerase chain reaction in the drained fluid, confirming the diagnosis of amebic liver abscess (ALA). However, the liver lesion has remained large over several years. Follow-up computed tomography showed the abscess measured 13.0 cm at 1 year and 9.2 cm at 3 years post-treatment. This case highlights a remarkably rare presentation of ALA, in which a giant liver lesion had not disappeared for years despite appropriate treatment, underscoring the need for caution in cases of severe ALA with fulminant progression.