Isolated amoebic splenic abscess: A case report on rare entity and diagnostic challenge

Rationale: Splenic abscess is an uncommon condition with a variety of aetiologies. Rare reports of isolated amoebic splenic abscesses in the literature make diagnosis difficult. Patient concerns: A 39-year-old male is reported in this case report as having left upper quadrant abdominal pain and a recent onset of fever. His USG abdomen demonstrated hypoechoic lesions in the spleen, which were confirmed as abscesses on computed tomography. In search of the aetiology, his blood culture was found to be negative, and echocardiography was normal. Due to endemicity, amoebic serology against Entamoeba histolytica was tested but had negative results. Diagnosis: Ultrasound-guided needle aspiration of a splenic abscess was performed, which depicted an anchovy sauce-coloured, thick fluid. The fluid culture was negative, but the real-time reverse transcription–polymerase chain reaction for E. histolytica appeared positive. Thus, the diagnosis of a primary isolated amoebic splenic abscess was made. Intervention: Recommended antibiotics were instituted. Outcome: The patient recovered completely. Lessons: The report describes a unique extraintestinal complication of E. histolytica and the clinical hurdles faced for the diagnosis, and knowledge of such a complication can make clinicians more vigilant.