Of an estimated 71 million individuals with chronic hepatitis C virus (HCV) infection worldwide, 10 to 15 million are estimated to live in sub-Saharan Africa (SSA). 1 Despite recommendations for a "treat-all" public health approach to reach elimination by 2030, 2,3 national treatment programs in many African countries and other resource-constrained settings still might have to prioritize HCV treatment for individuals with advanced liver fibrosis and cirrhosis. In settings with limited resources, there is little or no access to liver biopsy and transient elastography (TE) to determine fibrosis stage. Noninvasive tests, such as the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score, have demonstrated acceptable sensitivity and specificity to detect advanced fibrosis and cirrhosis in chronic hepatitis C (CHC). 4 However, there are limited data on the performance of these tests in SSA, where endemic conditions such as malaria, schistosomiasis, and human immunodeficiency Abbreviations: ALT, alanine aminotransferase; APRI, aspartate aminotransferase-to-platelet ratio index; AST, aspartate aminotransferase; AUROC, area under the receiver operating characteristic curve; CHC, chronic hepatitis C;

BACKGROUND: An adult patient presented with right abdominal pain and fever to a primary care physician and abdominal ultrasound was performed. With an initial diagnosis of a liver abscess, he was discharged from the hospital after treatment with antibiotics and drainage of the collection. However, the patient had persistent clinical findings on the same site which was later confirmed as Hepatocellular cancer.CASE PRESENTATION: A 40 years old male patient who was known to have Type 2 Diabetes and Hypertension for 10 years on oral medications referred to the Gastroenterology/Hepatology unit with right upper quadrant pain, loss of appetite, nausea, vomiting of ingested matter, and significant weight loss. On further inquiry, he had been admitted six months back for similar complaints and was managed with antibiotics and drainage of an abscess collection. The multi-phasic abdominal CT scan and raised alphafetoprotein confirmed Hepatocellular Cancer which initially has presented as a pyogenic liver abscess.CONCLUSION: Hepatocellular cancer should be suspected and early diagnosis should be made in individuals presenting with a liver abscess and having risk factors for liver cancer.