Abscesso hepático piogênico por Pseudomonas aeruginosa em pré-escolar

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Pyogenic hepatic abscess is a purulent collection secondary to bacterial infection in the hepatic parenchyma. Is relatively rare in general population, around 1.1 to 2.3/100.000 inhabitant, with mortality between 5.6-80%. In this study, we report the case of a preschool, male, with fourteen days of fever, abdominal distention, pallor, Torres-Homem sign, periumbilical hypertimpanism and hepatomegaly. He arrived with leukocytosis/neutrophilia, high reactive-C protein, normochromic/normocitic anemia, increased liver and canalicular enzymes, in addition to alteration of coagulation tests. Ultrasonography and abdominal tomography showed heterogeneous collections of irregular contours and inaccurate limits in segments IV, V, VII and VIII. Gallbladder of thickened walls with hyperechogenic image measuring 0.8cm. The initial treatment consisted of the association of ampicillin and sulbactam associated with metronidazol and transcutaneous drainage of the abscess guided by ultrasonography. With the positive culture of the abscess material for Pseudomonas aeruginosa, ciprofloxacin began and the performance of weekly abdominal ultrasound. He was discharged after ultrasonography of abdomen without abscesses. The triad of pyogenic hepatic abscess encompasses abdominal pain, intermittent fever and hepatomegaly. They are usually associated with predisposing factors from immunosuppression to biliary pathway pathologies and neoplasms. Percutaneous drainage guided by CT or US is currently first-line treatment. Even though it is rare, HA should be among the differential diagnosis options of abdominal pain and intermittent fever.