Liver Abscess

A 56-year-old man with a history of recurrent cholangitis presents with fever (39.2°C), right upper quadrant pain, and jaundice. Ultrasound reveals dilated intrahepatic bile ducts and a 4 cm hypoechoic lesion in the left lobe. Blood cultures grow *Klebsiella pneumoniae*. CT abdomen shows the lesion to be non-enhancing with peripheral enhancement. The patient is hemodynamically stable. What is the most likely diagnosis and the appropriate initial management?

A 38-year-old man from rural Maharashtra presents with a 3-week history of fever, right upper quadrant pain, and weight loss. He reports a history of dysentery 2 months ago. On examination, he is febrile (38.5°C), with hepatomegaly and right-sided abdominal tenderness. Ultrasound abdomen shows a 6 cm hypoechoic lesion in the right lobe of the liver with internal echoes. Blood culture is sterile. Serology for Entamoeba histolytica is positive. What is the most appropriate next step in management?

A 52-year-old man with type 2 diabetes and cirrhosis (Child-Pugh B) presents with fever (39.2°C), right upper quadrant pain, and jaundice. He has no recent instrumentation or biliary procedures. Blood cultures grow *Klebsiella pneumoniae*. Ultrasound shows a 4 cm hypoechoic lesion in the right lobe with internal debris and gas echoes. Serology for *Entamoeba histolytica* is negative. What is the most appropriate management?

Which organism is the most common cause of pyogenic liver abscess in India?

A 42-year-old man from rural Maharashtra presents with a 3-week history of fever, right upper quadrant pain, and weight loss. He reports a history of dysentery 2 months ago. On examination, he is febrile (38.5°C), tender over the right hypochondrium, with hepatomegaly. Ultrasound abdomen shows a 6 cm hypoechoic lesion in the right lobe of liver with internal echoes. Blood culture is sterile. Stool microscopy shows no parasites. What is the most likely diagnosis?