Case Of Multiple Liver Abscesses Research Articles

Multiple Liver Abscesses Caused byStreptococcus constellatus: A Case Report

Abstract Background: Pyrogenetic liver abscess is often caused by gram-negative bacilli, including Escheria coli or Klebsiella pneumoniae, but rarely by Streptococcus constellatus. Streptococcus constellatus is a commensal of the oral cavity, respiratory tract system, intestine, and urogenital organs. Herein, we report a case of multiple liver abscesses caused by Streptococcus constellatus. Case Presentation: A 66-year-old male presented with a high-grade fever with no known source. Laboratory analysis revealed severely elevated inflammation levels, moderately increased liver and biliary enzymes, and moderately worsened renal function. Sonazoid®(GE Healthcare AS, Oslo, Norway)-enhanced sonography revealed marginally contrast-enhanced masses with a non-contrast−enhanced center. On the basis of these results, the patient was diagnosed with multiple liver abscesses. Subsequently, meropenem 1 g/d was prescribed. On day two, percutaneous abscess drainage was performed. Culture from abscess drainage and blood c...

An Unusual Case of Multiple Liver Abscesses by All Means

Foreign bodies are commonly swallowed and migrate through the gastrointestinal system uneventfully. Sawing needles, pins, and fish bones were reported as common causes of gastrointestinal perforation and liver abscesses. Toothpicks have been less frequently reported probably due to the difficulties encountered with its identification on conventional imaging. We present the case of a 75-year-old man presenting with fever and shortness of breath. Physical examination revealed hypotension of 80/40 mmHg and fever of 101 °F. Lung examination showed crackles in the right lower lobe. His abdomen was soft and non-tender to palpation. The laboratory studies revealed normal WBC 6300/mm3 (16 000 next day), Hb of 7.6 g/dL, increased AST/ALT 81/96 IU/L and ALP 191 IU/L with normal bilirubin. The initial abdominal CT-scan demonstrated two abscesses in left hepatic lobe without identifying the culprit (figure 1). The patient was started on antibiotics with clinical improvement and liver enzymes normalization. Follow up CT scan confirmed the presence of a linear radiopaque foreign body extending from the distal stomach into the left hepatic lobe (figure 2). An upper endoscopy was then performed; the tip of a sharp wooden body was found in the gastric body. Removal of the foreign body was accomplished with a snare device (figure 3). A wooden toothpick of 5 cm was retrieved. Encountering a “cryptogenic” liver abscess without a distinguishable culprit should raise the suspicion for the presence of an underlying foreign body. This case was unusual by several means: the absence of abdominal focus on clinical presentation, the number of abscesses and missed foreign body on our first CT scan, the presence of direct hepatic penetration and finally the choice of endoscopy over surgical intervention.Figure: Frontal view of abdomen-pelvis CT scan (blue arrows underlies the presence of 2 ring enhanced lesions of 12 and 12mm in diameter).Figure: Frontal view of abdomen-pelvis CT scan (blue arrow showing the foreign body perforating the gastric wall at the lesser curvature and reaching the left hepatic lobe).Figure: Endoscopic images: arrow pointing at the foreign body in antrum during endoscopy.

多発肝膿瘍を伴い転移性腫瘍と鑑別が困難であった十二指腸乳頭部癌の1例

症例は69歳，女性．主訴は心窩部痛と発熱で，肝機能障害と炎症反応がみられ，内視鏡で乳頭部腫瘍による急性胆道炎と診断した．造影CTを行うと肝内に造影早期相で辺縁がリング状増強を示す低吸収性腫瘤が多発性に認められた．これら肝腫瘤は，USでは辺縁低エコー帯を伴う低エコー性腫瘤として，造影MRIは早期相で辺縁がリング状増強を示し，肝細胞相で低信号となり，転移性腫瘍の可能性が高いと考えた．FDG-PETは肝腫瘤に集積がなく，経過観察して肝腫瘤が消失したため，肝膿瘍と判断した．開腹所見も肝転移はなく治癒切除に至り，術後2年を経過し再発徴候はない．乳頭部癌は他の胆道癌よりも肝膿瘍を伴う頻度が高く，転移性腫瘍との鑑別診断において特に注意を要する．FDG-PETは転移と膿瘍の鑑別に有用であった．診断が困難な場合は，慎重な経過観察を行い短期間で再検することが重要と考えた．

A case of multiple liver abscesses associated with Streptococcus salivarius in a patient with chronic periodontitis

A case of multiple liver abscesses associated with <i>Streptococcus salivarius</i> in a patient with chronic periodontitis

Multiple Liver Abscesses Associated with Ventriculoperitoneal Shunt Infection: Case Report and Review of the Literature

Liver abscess following ventriculoperitoneal (VP) shunting occurs very rarely. We report an unusual case of multiple liver abscesses caused by Staphylococcus capitis in a 50-year-old compromised woman due to a complicating VP shunt infection. We reviewed the nine cases of VP shunt complications reported in the English literature, and speculated that the most likely pathogenetic mechanism in our case is an infected peritoneal tip that migrated to and penetrated the liver, which subsequently caused the formation of multiple liver abscesses. The patient was successfully treated with percutaneous aspiration, drainage of the abscesses, intravenous antibiotics, and shunt revision. Awareness and vigilance of the possibility of liver abscess formation caused by VP shunt infection will help establish an early accurate diagnosis and therapeutic strategy.

多発肝膿瘍をきたした進行胃癌の1例

進行性胃癌に伴うmucosal barrierの破壊による経血行性感染が原因と考えられた多発肝膿瘍の1例を経験したので報告する．症例は68歳，男性．術前検査にて胃体下部に5cm大3型腫瘍を認め，大腸に異常所見や肝転移，肝膿瘍を疑う所見も認めず，発熱もなく，手術目的にて入院．入院2病日より39℃におよぶ高熱が出現するも，腹部所見の変化は認めなかった．血液検査では高度な炎症反応を認め抗生剤の投与を施行した．腹部CTで肝に多発するtarget sign様所見を認め，血液培養ではグラム陰性桿菌が検出さ肝膿瘍と診断した．抗生剤投与にて炎症反応は徐々に低下し腹部CTでの肝膿瘍所見は縮小した．炎症反応の正常化および画像で肝膿瘍所見の消失を待って，入院第39病日に胃全摘，膵体尾部切除，脾摘，胆摘，回盲部腫瘤摘出術D2郭清を施行した．術後42カ月経過し肝膿瘍の再燃，再発所見認めず，外来follow中である．

Combined Hepatic and Splenic Abscesses in a Patient with Ulcerative Colitis

Liver abscesses are very rare complications of ulcerative colitis, and furthermore, there has been only one case of splenic abscess in a patient with ulcerative colitis reported in the English literature. We recently encountered a patient with ulcerative colitis accompanied by both hepatic and splenic abscesses. The patient was treated with abscess drainage as well as sulfasalazine and antibiotics. Follow-up sonography of the abdomen showed complete resolution of the lesions. To our knowledge, this is the first report of combined case of multiple liver abscesses combined with splenic abscess in a patient with ulcerative colitis.

Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: A case report

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease, and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC. Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas. However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.