Abstract No. 313: Pasteurization of hepatic abscesses with RFA in immunocompromised patients with chronic granulomatous disease

Abstract

To evaluate the clinical application and outcomes of radiofrequency ablation (RFA) of hepatic abscesses in patients with chronic granulomatous disease (CGD). Four CGD patients with a total of 22 liver abscesses were treated during 9 separate sessions of image guided RFA by open surgical (1 session) or percutaneous (8 sessions) access between 1999 and 2005. All patients signed informed consent for the procedure and were treated under a compassionate exemption mechanism. Liver abscesses in CGD patients typically develop into large fibrotic masses containing extensive granulomas and microabscesses causing them to be untreatable by conventional methods like tube drainage. Only patients for whom surgery was medically contraindicated or who refused surgery were eligible to undergo RFA. All liver abscesses treated with RFA were successfully eradicated by radiographic criteria, with the first 3 demonstrating microbiological inactivity following surgical resection (1 lesion) or biopsy (2 lesions) immediately following RFA. The rest of the treated lesions remained free of radiographic evidence for abscess from 1 to 77 months follow-up (mean of 40.7months). Three of 4 patients had liver abscesses clinically and radiographically eradicated, and were without acute or chronic complications. One patient developed septic shock during RFA, likely due to a toxin-producing organism, and died 36 days following RFA. Screening methods for the specific toxin-producing organism have been implemented prior to consideration for RFA in the patient population. RFA can successfully treat liver abscesses in patients with chronic granulomatous disease. Optimal drainage of pus or screening for specific bacterial exotoxins prior to liver abscess RFA might avoid RFA-related toxic shock-like syndrome.