E. histolytica infection occurs due to ingestion of cysts in contaminated food or water. The parasite is present widely in the tropics and subtropics causing up to 40 million infections on an annual basis ¹. As in this case, the patient was a migrant from a developing tropical country. 

When cysts reach the small intestine, excystation occurs resulting in trophozoites that penetrate the mucosa of the bowel ¹ . Access to the portal venous system via this route may result in infection of the liver, brain, lungs, and pericardium. Abscess of the liver is the most common site of extraintestinal infection but occurs in less than 1% of infections ¹. 

E. histolytica disease results in up to 100,000 deaths annually and is the third leading parasitic cause of death in developing countries ². It is important to note, however, that clinical disease only occurs in a minority of infections and amoebic liver abscesses can develop years later following initial infection as was likely the case in this patient ². 

Complete resolution of E. histolytica liver abscesses on imaging may take up to two years, and therefore imaging features alone should not dictate management ³.