Case report: Diagnosis and resolution of hepatic abscess in a neonate

Abstract

BACKGROUND: Hepatic abscesses in the neonatal age can be caused by multiple etiologies and their variability in clinical presentation makes their diagnosis difficult. The incidence of infectious liver abscesses is low, however, their mortality is high and their timely diagnosis and early resolution are essential to improve prognosis and life expectancy, since therapeutic management is the cause of prolonged hospitalization due to the administration of long-lasting intravenous antimicrobials. The following is a case report of a neonatal patient with this pathology. CLINICAL REPORT: neonatal patient born by cesarean section, 38 weeks of gestation, male, admitted to the neonatology department due to the need for mechanical ventilation; with umbilical catheters for 72 hours. At 48 hours of life, he presented febrile peaks and elevation of acute phase reactants, later, abdominal distension, feeding intolerance and hepatomegaly, so antibiotic therapy was administered with suspicion of septic ileus. Due to persistent hepatomegaly, an abdominal ultrasound was performed in which cystic images were observed at the hepatic level. EVOLUTION: after the diagnosis of liver abscesses, it was decided to maintain antibiotic therapy with Meropenem and Vancomycin. Due to persistence of the abscesses despite treatment, surgical drainage was required on two occasions, the first at day 30 of life, and the second at 47 days of life. The newborn received, from the onset of symptoms and clinical symptoms, a total of 60 days of Meropenem and 48 days of Vancomycin, with complete resolution of the lesions after 68 days of hospitalization. CONCLUSION: Hepatic abscesses are rare in the neonatal age, of bacterial origin in most cases, related to hematic propagation due to umbilical catheterization. The pathology involves long hospitalizations and long-term antibiotic therapy; however, its prognosis is good with early diagnosis and timely treatment.