Unusual Case of Hepatic Amebiasis Without Recent Endemic Exposure: A Diagnostic Puzzle

<i>Entamoeba histolytica</i> is a parasite endemic to many countries. While many people who are infected remain asymptomatic, serious complications can also occur. We report the case of a 25-year-old male immigrant from Guatemala who presented to the ED with epigastric pain and non-bloody diarrhea. Abdominal imaging revealed at least 10 hypodense liver lesions, prompting a further workup. He was subsequently diagnosed with invasive amebiasis infection due to <i>E. histolytica</i> and was initiated on appropriate antimicrobial therapy. This case underscores the importance of maintaining a broad infectious differential when evaluating hepatic lesions, even in patients without a recent travel history. This case is unique due to the presence of multiple amoebic abscesses in a patient living in a non-endemic region with a remote immigration history and potential sexual transmission. This report highlights a rare presentation of a relatively common infection in a patient without recent travel or known exposure, emphasizing the need for clinical vigilance in non-endemic settings.