Abstract
IntroductionA liver abscess in Crohn’s disease is a rare but important entity that is associated with a poor prognosis and high mortality when treatment is delayed. We report a case of successful liver segmentectomy for a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment.Case presentationA 31-year-old Japanese man, who had been treated with infliximab infusions for Crohn’s disease, was referred to our hospital presenting with an abrupt onset of high fever and an elevated white blood cell count and serum C-reactive protein level. Computed tomography revealed a liver abscess occupying segment 8. The limited effect of percutaneous transhepatic abscess drainage and antibiotics led us to perform radical resection of the abscess. The patient recovered quickly after surgery and the postoperative course was uneventful.ConclusionThe present case suggests that surgical removal of an abscess should be considered for patients under immunosuppression or refractory to conventional treatment.
Highlights
A liver abscess in Crohn’s disease is a rare but important entity that is associated with a poor prognosis and high mortality when treatment is delayed
The present case suggests that surgical removal of an abscess should be considered for patients under immunosuppression or refractory to conventional treatment
We report a case of a large solitary methicillinresistant Staphylococcus aureus (MRSA) liver abscess localized in Couinaud’s segment 8 in a patient with Crohn’s disease under infliximab treatment, which was successfully resected and cured by anatomic liver resection following medical and interventional treatment failure
Summary
Infliximab treatment has recently emerged as a safe and effective method of inducing and maintaining remission of Crohn’s disease [1,2,3], but the immunosuppression sometimes results in unexpected complications, such as infection with Mycobacterium tuberculosis, sepsis, severe pneumonia, severe liver dysfunction, and leucopenia. A second operation for ileal stenosis was performed with a partial ileum resection and a new ileostomy six years before the admission He had not been treated with methylprednisolone, but underwent infliximab treatment two years before the admission to induce remission because of further exacerbation of the disease. Laboratory data revealed severe inflammation with a white blood cell count of 20400/μL with 80% neutrophils, a serum C-reactive protein level of 25.0mg/dL, a serum fibrin degradation products level of 26μg/mL, and a serum D-dimer level of 11.6μg/mL His liver function was slightly impaired with increased aspartate and alanine aminotransferase levels (87IU/L and 149IU/L, respectively); no other organ impairment was observed. Without any improvement in the patient’s general condition and clinical findings after seven days of teicoplanin treatment with additional interventional treatments, we decided to perform urgent radical resection of the abscess. No evidence of recurrent liver abscess or Crohn’s disease progression has been observed in the four months after the resection, with oral administration of three g/day of PENTASAW (mesalamine) and 500mg/day of ciprofloxacin
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