Gastrointestinal Origins of Pyogenic Liver Abscess

Abstract

The misdiagnosis of the underlying cause of Klebsiella pneumoniae bacteremia1Uehara K, Harada Y. Misdiagnosis of liver abscess resulting from misunderstood culture results [epub ahead of print]. Am J Med. doi.org/10.1016/j.amjmed.2019.07.040Google Scholar was compounded by a failure to perform gastrointestinal investigations, such as colonoscopy and gastroduodenoscopy, to ascertain whether gastrointestinal malignancy was a source of infection culminating in pyogenic liver abscess. Notwithstanding the zero-detection rate for colorectal carcinoma in the prospective colonoscopic evaluation of 62 patients with pyogenic liver abscess (where 28 cases had adenomatous polyps, including only 1 with high-grade dysplasia),2Heo N-Y Hong YM Kim TO et al.The prevalence of colonic neoplasm in cryptogenic pyogenic liver abscess: a prospectively enrolled cross-sectional study.Korean J Gastroenterol. 2016; 68: 195-201Crossref PubMed Scopus (3) Google Scholar anecdotal reports3Tajima T Mukai M Hasegawa S et al.Early rectal cancer accompanied by multiple systemic abscesses: a case report.Oncol Lett. 2015; 10: 2219-2222Crossref Scopus (3) Google Scholar,4Kim HY Kim CW Kim DR et al.Recurrent pyogenic liver abscess as a presenting manifestation of colorectal cancer.Korean J Intern Med. 2017; 32: 174-177Crossref Scopus (3) Google Scholar and case series5Chen YY Lee JC Yen HH Wu S. Soon MS Pyogenic liver abscess and colorectal neoplasia: a case series.Scand J Infect Dis. 2012; 44: 848-851Crossref PubMed Scopus (6) Google Scholar,6Qu K Liu C Wang Z-X et al.Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia.World J Gastroenterol. 2012; 18: 2948-2955Crossref PubMed Scopus (34) Google Scholar reveal a strong association between pyogenic liver abscess and colorectal carcinoma. K. pneumoniae pyogenic liver abscess may be the first clue to early rectal cancer, as was the case in a 70-year-old man who had diabetes as well.3Tajima T Mukai M Hasegawa S et al.Early rectal cancer accompanied by multiple systemic abscesses: a case report.Oncol Lett. 2015; 10: 2219-2222Crossref Scopus (3) Google Scholar And as shown in another report, K. pneumoniae-related pyogenic liver abscess may regress after combined percutaneous drainage and systemic antibiotic treatment only to recur if the underlying source of infection, namely, colorectal carcinoma, is not identified and treated.4Kim HY Kim CW Kim DR et al.Recurrent pyogenic liver abscess as a presenting manifestation of colorectal cancer.Korean J Intern Med. 2017; 32: 174-177Crossref Scopus (3) Google Scholar In a retrospective study in which 211 patients with pyogenic liver abscess had been retrospectively evaluated for the association of pyogenic liver abscess and colorectal neoplasia, 12 patients with that association were identified, characterized by focal adenocarcinoma in tubulovillous adenoma (3 cases), and adenomatous polyps (9 cases). None had gastrointestinal symptoms.5Chen YY Lee JC Yen HH Wu S. Soon MS Pyogenic liver abscess and colorectal neoplasia: a case series.Scand J Infect Dis. 2012; 44: 848-851Crossref PubMed Scopus (6) Google Scholar A literature review published in 2012 identified 96 cases of pyogenic liver abscess in the international literature up to September 2011. These were pyogenic liver abscess cases associated with nonmetastatic colorectal carcinoma. The global distribution was predominantly Eastern Asian (77 cases), the rest were spread across the Middle East, Europe, and North and Central America. K. pneumoniae accounted for 50% of 58 cases in which pus was evaluated, and the rest were accounted for by a variety of gram-negative and gram-positive bacteria and also by amoebae (2 cases); 10 cases had sterile pus.6Qu K Liu C Wang Z-X et al.Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia.World J Gastroenterol. 2012; 18: 2948-2955Crossref PubMed Scopus (34) Google Scholar The key process that culminates in neoplasia-related pyogenic liver abscess is believed to be a compromised mucosal barrier that facilitates bacterial invasion of the portal circulatory system, with subsequent hematogenous spread of bacteria to the liver.6Qu K Liu C Wang Z-X et al.Pyogenic liver abscesses associated with nonmetastatic colorectal cancers: an increasing problem in Eastern Asia.World J Gastroenterol. 2012; 18: 2948-2955Crossref PubMed Scopus (34) Google Scholar