Case Of Pyogenic Liver Abscess Research Articles

A challenging case of carbapenem resistant Klebsiella pneumoniae-related pyogenic liver abscess with capsular polysaccharide hyperproduction: a case report

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are a major public health problem, necessitating the administration of polymyxin E (colistin) as a last-line antibiotic. Meanwhile, the mortality rate associated with colistin-resistant K. pneumoniae infections is seriously increasing. On the other hand, importance of administration of carbapenems in promoting colistin resistance in K. pneumoniae is unknown.Case presentationWe report a case of K. pneumoniae-related pyogenic liver abscess in which susceptible K. pneumoniae transformed into carbapenem- and colistin-resistant K. pneumoniae during treatment with imipenem. The case of pyogenic liver abscess was a 50-year-old man with diabetes and liver transplant who was admitted to Abu Ali Sina Hospital in Shiraz. The K. pneumoniae isolate responsible for community-acquired pyogenic liver abscess was isolated and identified. The K. pneumoniae isolate was sensitive to all tested antibiotics except ampicillin in the antimicrobial susceptibility test and was identified as a non-K1/K2 classical K. pneumoniae (cKp) strain. Multilocus sequence typing (MLST) identified the isolate as sequence type 54 (ST54). Based on the patient’s request, he was discharged to continue treatment at another center. After two months, he was readmitted due to fever and progressive constitutional symptoms. During treatment with imipenem, the strain acquired blaOXA−48 and showed resistance to carbapenems and was identified as a multidrug resistant (MDR) strain. The minimum inhibitory concentration (MIC) test for colistin was performed by broth microdilution method and the strain was sensitive to colistin (MIC < 2 µg/mL). Meanwhile, on blood agar, the colonies had a sticky consistency and adhered to the culture medium (sticky mucoviscous colonies). Quantitative real-time PCR and biofilm formation assay revealed that the CRKP strain increased capsule wzi gene expression and produced slime in response to imipenem. Finally, K. pneumoniae-related pyogenic liver abscess with resistance to a wide range of antibiotics, including the last-line antibiotics colistin and tigecycline, led to sepsis and death.ConclusionsBased on this information, can we have a theoretical hypothesis that imipenem is a promoter of resistance to carbapenems and colistin in K. pneumoniae? This needs more attention.

Pyogenic liver abscess as an extra-intestinal manifestation of pediatric Crohn’s disease

Crohn’s disease (CD) is a type of inflammatory bowel disease (IBD) characterized by chronic granulomatous inflammation of any part of the body, primarily the gastrointestinal (GI) tract, and is increasing in incidence worldwide. As CD is a systemic disease, the features of CD typically manifest in the GI tract; however, a variety of extra-intestinal manifestations, such as the involvement of joints, skin, and eyes may also occur. Although pyogenic liver abscess itself is rare in the general population (approximately 3–5 per 100,000 hospital admissions), it is also an unusual and rare presentation in pediatric CD patients. In this report, we present a case of pyogenic liver abscess in a 7-year-old female CD patient and discuss the clinical features, laboratory findings, imaging studies, and pathologic report of liver biopsy.

Diabetes and obesity and risk of pyogenic liver abscess

Few literatures discussed the relationship of glycemic control and body mass index (BMI) with the risk of pyogenic liver abscess. We conducted a population-based cohort study using participants of a community-based health screening program in Taiwan from 2005 to 2008 (n = 125,865). Information on fasting plasma glucose (FPG), BMI, and other potential risk factors of liver abscess were collected at baseline. Incidence of pyogenic liver abscess was ascertained using inpatient records from the National Health Insurance database. During a median 8.6 years of followed up, 192 incident cases of pyogenic liver abscess were reported. The incidence rate of pyogenic liver abscess was 70.2 and 14.7 per 100,000 in the diabetic and non-diabetic population respectively. In multivariable Cox regression analysis, the adjusted hazard ratio (HR) was 2.18 (95% confidence interval (CI) 1.22–3.90) in patients with diabetes with good glycemic control (FPG ≤ 130 mg/dl) and 3.34 (95% CI 2.37–4.72) in those with poor glycemic control (FPG > 130 mg/dl), when compared with non-diabetics. In the dose–response analysis, the risk of liver abscess increased monotonically with increasing FPG. After adjusting for diabetes and other comorbidities, overweight (25 ≤ BMI < 30) (adjusted HR: 1.43, 95% CI 1.05–1.95) and obese (BMI ≥ 30) (adjusted HR: 1.75, 95% CI 1.09–2.81) populations had a higher risk of liver abscess when compared to people with normal weight. Diabetes, especially poorly controlled disease, and high BMI were associated with higher risk of pyogenic liver abscess. Improving glycemic control and weight reduction may reduce the risk of developing pyogenic liver abscess.

S3285 A Rare Case of Pyogenic Liver Abscess Caused by Raoultella ornithinolytica

Introduction: Patients with a history of splenectomy have a higher prevalence of infections with encapsulated organisms due to decreased phagocytic activity and humoral response. One such rare organism is Raoultella ornithinolytica, a Gram-negative bacillus commonly found in the aquatic environment. Here we present a rare case of this bacterium causing liver abscess. Case Description/Methods: A 72-year-old female with a history of hypertension, hyperlipidemia, and splenectomy (secondary to abdominal trauma) presented after being found down. She complained of a recent history of diarrhea 2 days ago. Blood pressure was 80/60 mmHg and temperature was 101 degrees F at presentation. She was found to have elevated liver enzymes and Klebsiella oxytoca bacteremia (found on Verigene multiplex PCR testing) and was started on broad-spectrum antibiotics. CT of the abdomen in the emergency room revealed a 3x2x5 cm hypodense lesion in the left lobe of the liver. She underwent ultrasound-guided removal of 35 cc dark brown colored fluid, which was positive by culture for Raoultella ornithinolytica. Her antibiotics were narrowed to cefazolin, and the infection was thought to be related to recent diarrhea (of unknown etiology) resulting in intestinal mucosal damage leading to translocation of the bacterium across the intestinal wall into the liver. Of note, on high specificity microbiological testing using matrix assisted desorption-time of flight (MALDI-Tof) technology, the organism recovered from the blood was confirmed to be Raoultella ornithinolytica. Discussion: Incidence of Raoultella ornithinolytica infection has been on the rise in the past decade, and our patient is the second reported case of Raoultella ornithinolytica liver abscess. In humans, it usually causes skin flushing, vomiting, diarrhea, and headache. While the first case, as reported by Surani et al in 2020, had a long-standing liver cyst that was thought to be infected with Raoultella ornithinolytica, our patient did not have any nidus in the liver that could harbor this bacterium. However, she had a history of splenectomy, possibly putting her at higher risk of infection with encapsulated bacteria. In addition, Raoultella ornithinolytica is closely related to Klebsiella oxytoca, but is not recognized in the multiplex PCR database which accounts for the discrepancy in initial identification as seen in our case. Our case adds to the growing literature regarding Raoultella ornithinolytica as an increasing virulent pathogen in humans.

First Italian report of a liver abscess and metastatic endogenous endophthalmitis caused by ST-23 hypervirulent Klebsiella pneumoniae in an immunocompetent individual

BackgroundKlebsiella pneumoniae is a common species in the gut of mammals and is widely distributed in the environment. However, the environmental source of hvKp that precedes gut colonization is unclear, but once that it reaches the gut there is a possible generalized spread y fecal-oral transmission especially in endemic areas. Liver abscess might develop when the bacteria, using its virulence factors, cross the intestinal barrier and invade the liver by the portal circulation. This syndrome, prevalent mostly in Asian countries, is increasingly reported in Western Countries and leaves open questions about the source of infection.CaseHere we describe for the first time in Italy, a case of pyogenic liver abscess caused by a hypervirulent Klebsiella pneumoniae (HvKp) complicated by endophthalmitis and other metastatic infections in lung and prostate in an immunocompetent Chinese healthy individual with no recent travel in Asia.ConclusionThis case underlines the need for increased awareness of hypervirulent K. pneumoniae, even in settings where it occurs infrequently and where there are not evident epidemiological links.

Pyogenic Liver Abscess Caused by Staphylococcus hominis: A Case Report

Abstract Staphylococcus hominis is a component of the normal human microflora and is considered to be an opportunistic pathogen that may cause a variety of infections. It has been reported to cause bacteremia, endocarditis and endophthalmitis. However, abscesses caused by S. hominis are rarely documented. Here, we describe a case of pyogenic liver abscesses caused by S. hominis. Laboratory tests, imaging examinations, and abscess puncture fluid culture were used to identify the etiology and pathogenic bacterium. This case suggests that percutaneous drainage and targeted antibiotic treatment according to the results of antimicrobial susceptibility tests are effective therapeutic approaches for pyogenic liver abscesses caused by S. hominis.

“Self-Referred” – A Physician’s experience of referred ear pain as a symptom of pyogenic liver abscess, a case report

• Secondary otalgia is a novel presenting symptom for pyogenic liver abscess. • This could be explained as referred pain from irritation of the vagus nerve. • The primary author of this case was also the patient. The presenting symptoms of liver abscess are typically non-specific, including pyrexia, right upper quadrant tenderness, nausea/vomiting and fatigue. We discuss a case of pyogenic liver abscess which presented with non-specific symptoms and severe left-sided ear pain. To our knowledge, this is a previously unreported presenting symptom of liver abscess in adulthood. This case is also somewhat unique in that the primary author is the patient in question. A young male patient in his twenties, working as a junior doctor, presented with a seven-day history of intermittent pyrexia, fatigue, nausea, vomiting and severe left-sided ear pain. A CT abdomen/pelvis revealed a large liver abscess in the right hepatic lobe. A percutaneous drain was inserted with US guidance and the patient completed a prolonged course of antibiotics (14 weeks total) with CT-confirmed resolution of the abscess at that point. The left-sided ear pain resolved within hours of the percutaneous drain insertion. To our knowledge, this is the first reported case of a liver abscess in an adult patient presenting with severe left-sided ear pain. We propose that this pain was secondary otalgia due to vagus nerve irritation at the level of the liver abscess.

S2802 "I Only Ate One Burger!" A Gastritis That Turned Into a Nightmare: A Case of Pyogenic Liver Abscess by Escherichia coli ESBL Positive in a Middle-Aged Male

S2802 "I Only Ate One Burger!" A Gastritis That Turned Into a Nightmare: A Case of Pyogenic Liver Abscess by Escherichia coli ESBL Positive in a Middle-Aged Male

Clinical features and etiological analysis for 157 cases of pyogenic liver abscess.

To analyze the clinical features and the pathogenic constituent of patients with pyogenic liver abscess (PLA), and to find the risk factors of the multidrug resistance (MDR) pyogenic liver abscess (MDR-PLA) for effective therapy in the PLA patients. We reviewed the PLA patients with antibiotics susceptibility test, who admitted to Xiangya Hospital of Central South University from Jan. 2010 to Dec. 2019. A total of 157 cases were divided into 2 groups: an MDR-PLA group (n=52) and a non-MDR-PLA group (n=107). The clinical data such as age, symptoms, laboratory and imaging data, and etiological test especially drug sensitivity test of the 2 groups were collected. Logistic regression analysis was performed for the risk factors of MDR-PLA. Anorexia (90.38%) and abdominal pain (63.46%) were more common in the MDR-PLA group than those in the non-MDR-PLA group (P<0.05). The proportions of patients with hepatolithiasis (34.62%) and biliary tract operation (38.62%) were higher in the MDR-PLA group than those in the non-MDR-PLA group (P<0.05). Klebsiellapneumoniae (59.94%) was the most common pathogen, which was sensitive to most of the antibiotics, while Escherichia coli and Enterococcus had lower drug sensitivity than Klebsiella lebsiella pneumoniae. The MDR-Enterococcus was 6.5 times of non-MDR-Enterococcus. And the multidrug resistance Klebsiella pneumoniae was 3.4 times of non-MDR-Klebsiella pneumoniae. Logistic regression analysis showed that hepatolithiasis (OR=4.895, 95% CI 1.455 to 16.463, P=0.001) and biliary tract operation (OR=3.860, 95% CI 1.156 to 12.889, P=0.004) were the risk factors for the MDR-PLA patients. The PLA patients with hepatolithiasis and billary tract operation history and the pathogenic bacterium of Escherichia coli and Enterococcus bacteria should be alerted for MDR bacterial infection.

Lactobacillus gasseri liver abscess and bacteremia: a case report

BackgroundLactobacillus is a genus of Gram-positive non-spore-forming rods usually found in the microbiota of the oral cavity, gastrointestinal tract, and female genitourinary tract. Also, they are commonly used in the food industry as supplements and probiotics. Lactobacilli are normally considered non-pathogenic to the human body, however, under certain circumstances such as immunosuppression, they can cause severe infections, with only a few cases of bacteremia, infective endocarditis, pneumonia, meningitis, and intra-abdominal infections reported. Among these presentations, a pyogenic liver abscess is rather rare.Case presentationWe describe the case of a 59-year-old man with a history of diabetes mellitus and multiple abdominal surgeries with the latest being in 2014 presenting with bacteremia and multiple large pyogenic liver abscesses due to Lactobacillus gasseri, which did not appear to be related to the use of probiotics or immunosuppression.ConclusionsGiven the high prevalence of diabetes mellitus and the increased use of probiotics, it is expected that in the future we will see an increase in infections caused by Lactobacilli. Medical management with antibiotics and percutaneous drainage were successful strategies for the treatment of this unusual case of pyogenic liver abscesses and bacteremia caused by Lactobacillus gasseri.

S2251 Liver Abscess Associated With Diverted Ileal Pouch

INTRODUCTION: Pyogenic liver abscess (PLA) is a rare disease with an incidence of 3.6 cases per 100,000 in the United States. There is no existing literature about PLA developing in a patient with UC who had undergone long-term bowel diversion. We present the first case of a patient with chronic pouchitis and recurrent stricture formation, presenting with a PLA. CASE DESCRIPTION/METHODS: 46-year-old female with UC status post-total proctocolectomy with ileal pouch-anal anastomosis (IPAA) at age 22 and loop ileostomy at age 43 presented to an outside hospital with a three-week history of intermittent right upper quadrant abdominal pain and increased non-bloody ileostomy output. Her UC had been complicated by a history of anal fistula, chronic pouchitis and recurrent strictures treated with needle knife stricturotomy (NKSt) every six months. The last NKSt session was four months prior to admission. On presentation, the patient was hypotensive and tachycardia. Labs revealed WBC count of 13,600/mm 3 , hemoglobin 8.8 g/dL, AST/ALT 157/170 IU/L, ALP 95 IU, and total bilirubin 0.9 mg/dL. The patient was started on IV fluids and empiric meropenem. Abdominal ultrasound revealed a liver mass, and abdominal CT showed a 10 cm heterogeneous liver mass concerning for malignancy.The next day she was transferred to our institution for further evaluation. A repeat abdominal CT scan showed a 12.7 cm hepatic abscess with a mass effect on the main portal vein. Liver abscess was drained and fluid cultures were positive for streptococcus anginosus. Patient was discharged on IV meropenem for an additional 3 weeks before being switched to oral amoxicillin-clavulanate for an additional 2 weeks. Three months later the patient underwent surgical excision of the diverted pouch and creation of end ileostomy, to prevent future risk of PLA. DISCUSSION: This report highlights the first case of pyogenic liver abscess in a patient with a long-standing history of diversion pouchitis and recurrent pouch strictures. Previously, twelve cases of PLA associated with UC have been reported. The associated pathogens were usually normal gut flora, such as the Streptococcus anginosus family. In animal models the mucosa in a diverted colon becomes a breeding ground for bacteria, increasing the probability of bacterial penetration through the mucosal barrier. Pouch excision and permanent diversion is necessary if there is pouch failure due to pelvic sepsis, chronic pouchitis or recurrent stricture/fistula formation in the pouch.Figure 1

Pediatric Liver Abscess: Trends in the Incidence, Etiology, and Outcomes Based on 20-Years of Experience at a Tertiary Center.

Background: Liver abscess is an important but relatively rare disease in children. This study investigated the clinical characteristics of eligible patients at a referral tertiary center over the past two decades.Method: A 20-year retrospective study (January 2000–December 2019) enrolled 38 children diagnosed with liver abscess. Demographic data; clinical features; laboratory, imaging, and microbiological findings; management strategy; and outcomes were reviewed from the patients' medical records.Results: Thirty-eight cases of pyogenic liver abscess were identified without a culture-proven amebic or fungal abscess. The mean age of diagnosis was 9.6 ± 6.2 years, and the male-to-female ratio was 1.92: 1. Hemato-oncological (28.9%) and predisposing hepatobiliary diseases (23.7%) were the two most common predisposing factors. Fever (94.7%) was the most common presentation followed by right upper quadrant abdominal pain (42.1%) and pleural effusion (34.2%). Among the laboratory parameters, leukocytosis was common (70.3%), and all patients had elevated serum C-reactive protein levels. Increased serum levels of alanine aminotransferase, aspartate aminotransferase, direct bilirubin, and total bilirubin were found in 40.5, 48.6, 23.1, and 42.9% of the cases, respectively. The most common pathogen in blood and pus cultures was Klebsiella pneumoniae. The mean durations of intravenous antibiotic and total antibiotic use were 29.0 ± 15.7 and 45.1 ± 22.1 days, respectively. Twelve patients (31.6%) were treated with antibiotics alone, while percutaneous needle aspiration, percutaneous pigtail drainage, and surgical intervention were performed in 12 (31.6%), 10 (26.3%), and 5 (13.2%) patients, respectively. No mortality was documented in this series.Conclusion: The present study reflects a relatively declining incidence of liver abscess compared with prior studies in Taiwan. K. pneumoniae remains the most prevalent pathogen in both blood and abscess cultures in Taiwan. Proper antimicrobial therapy with timely drainage generally yielded an adequate treatment response without any mortality.

2968 Juxta-Papillary Duodenal Diverticulum (JPDD) Are Associated With Pyogenic Liver Abscesses

INTRODUCTION: Juxta-papillary duodenal diverticulum (JPDD) has been implicated by association as a potential risk factor for ascending cholangitis. Putative mechanisms include periampullary colonization of pathogenic bacteria and mechanical obstruction. The relationship of JPDD to liver abscess has not been described. We hypothesize that JPDD is associated with pyogenic liver abscess (PLA). METHODS: We conducted an IRB approved retrospective chart review from 2008 to 2018 to identify 66 cases of pyogenic liver abscess. Inclusion criteria for the diagnosis of liver abscess included CT imaging and either culture or confirmed resolution after antibiotic therapy. A similar number of age and sex matched controls were identified who had abdominal CT scan performed for another reason. All cases and controls were reviewed by a single expert radiologist to identify the presence of JPDD. Chi square statistic was used to test our hypothesis. RESULTS: 8 out of 66 cases of PLA had JPDD compared to only 2 out of 66 controls. Chi square testing was statistically significant for association between JPDD and PLA (Chi Square statistic = 3.89; P = 0.048). CONCLUSION: JPDD has statistically significant association with PLA. This may suggest a role of JPDD in etiology of “idiopathic” liver abscesses by either mechanical effect or by increased colonization by the pathogenic bacteria.

Two cases of pyogenic liver abscess due to &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; in immunocompetent children

Two cases of pyogenic liver abscess due to &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; in immunocompetent children

Case of Pyogenic Liver Abscesses Caused by Klebsiella Pneumoniae

Liver abscess is a serious intraabdominal infection can be due to result of bacteria, fungi, or parasites infection. Until the end of the last century, pyogenic liver abscesses were predominantly caused by mixed aerobic and anaerobic bacteria, the most frequent isolate being Escherichia coli [1]. Klebsiella pneumoniae (K.pneumoniae) is a known cause of pyogenic liver abscess (PLA) in the absence of hepatobiliary disease. In settings of hepatic infection, it has also been known to cause disseminated infections including meningitis and endopthalmitis. Patients with diabetes mellitus and the preexisting hepatobiliary disease are particularly susceptible to infection as well as those from Southeast Asia [2]. We present a case of Klebsiella liver abscess with bacteremia.

&lt;i&gt;Fusobacterium&lt;/i&gt;による化膿性肝膿瘍9症例の臨床的検討―本邦報告例のreview―

&lt;i&gt;Fusobacterium&lt;/i&gt;による化膿性肝膿瘍9症例の臨床的検討―本邦報告例のreview―

Isolated Pyrexia: The Hunt for Disease in a Patient Without Discernible Risk Factors

Hepatic abscesses are relatively rare and require prompt recognition and early intervention to reduce morbidity and mortality, which may be significant if left untreated. We present a case of pyogenic liver abscess with atypical presentation and absence of discernable risk factors. 59-year-old male with a history of hypertension and hyperlipidemia presented to the emergency department with complaints of daily fevers for approximately 4 days reaching a maximum temperature of 104.1°F. The fevers did not follow any particular pattern, were partially relieved by acetaminophen, and were associated with fatigue but no chills. He denied any abdominal or chest pain, dyspnea, nausea, vomiting, diarrhea, constipation, dysuria, headache, neck stiffness, rash, arthralgia, joint swelling, back pain, sore throat or any other symptom. He had no recent medication changes, history of prosthetic joint or valve replacement, or history of surgery. He underwent annual dental evaluations with no recent dental cleanings and was up to date on his screening colonoscopy with follow up in 8 years. On physical exam, his vital signs were normal except tachycardia to 113 beats per minute and a temperature of 102.9F. He was alert and in no acute distress. His physical exam was absent for any abnormality with unremarkable head, neck, cardiac, lung, abdominal, extremity and skin exam. Laboratory analysis was significant for elevated liver enzymes and a mild leukocytosis. An abdominal ultrasound showed a lobulated circumscribed heterogeneous mass suspicious for malignancy or abscess that was later confirmed on CT scan. He was found to have elevated ESR, CRP, and procalcitonin values with an undetectable alpha fetoprotein. Antibiotics were initiated and he underwent percutaneous hepatic drain placement. Blood cultures were positive for streptococcus intermedius. Dental evaluation via xray panorex and CT neck studies were negative for dental infection. Transthoracic and transesophageal echo evaluation were negative for endocarditis. He improved and discharged home with hepatic drain in place and antibiotic infusions until he showed clinical evidence of resolution of infection. This case illustrates a potentially lethal infectious process that presented in an atypical manner and without known risk factors. It emphasizes the significance of maintaining clinical suspicion for occult abscess and prompt but appropriate imaging if there are no clear foci of infections with respect to history.Figure 1Figure 2

An Unusual Case of Hepatic Abscess After Rectal Use of Crystal Methamphetamine

Pyogenic Liver abscess occurs most commonly as a complication of biliary tract infection. We describe the first case of hepatic abscess developing in a patient with colitis secondary to rectal methamphetamine use. A 35 year old gentleman presented with RLQ abdominal pain, loose stools with mucus and painful defecation for 4 days. He is a homosexual male with a history of HIV on HAART, recurrent pancreatitis and multiple episodes of infectious colitis. A week before the symptoms, he had receptive sex, and used methamphetamine rectally. On admission, he was afebrile with stable vital signs and RLQ tenderness. Labs revealed mild leukocytosis, and elevated LFTs. CT scan was suggestive of an infectious or inflammatory proctocolitis, and a new 1.9 cm hypodensity in the right hepatic lobe. MRI of the abdomen showed 3.0 cm multi-loculated cystic collection representing intrahepatic abscess, with no significant biliary dilation. Rectal swab was positive for chlamydia, stool was negative for other pathogens including cyclospora and cryptococcus, viral hepatitis panel was negative. He was placed on meropenem for 6 weeks, and the abscess resolved. Pyogenic liver abscesses are the most common kind of visceral abscesses, usually arises in the setting of biliary disease, and less commonly as a consequence of portal vein pyema secondary to diverticulitis, appendicitis, perforated or penetrating peptic ulcer, GI malignancy, IBD, or peritonitis, in many cases it can be cryptogenic. The right lobe of the liver is usually affected, having better blood supply than the left or caudate lobes. We describe a rare case of pyogenic liver abscess in the setting of proctocolitis, in an MSM patient using rectal methamphetamine. There was no recent travel history that would suggest amoebic abscess, and no biliary disease was evident on imaging. There are only a few cases in the literature of transrectal use of methamphetamine, with associated methamphetamine toxicities. However, this is the first case that describes inflammatory colitis associated with methamphetamine use, and the only case to describe liver abscess in this setting. Transrectal methamphetamine abuse and rectal body stuffers are becoming more common, especially in the MSM community, and should be recognized as a possible cause of colitis, and pyogenic liver abscess.Figure 1Figure 2

Clostridium difficile: A rare cause of pyogenic liver abscess

Extra-intestinal infections due to Clostridium difficile have been reported rarely. Herein we report a case of pyogenic liver abscess from toxigenic C. difficile in an 80-year-old non-hospitalized woman with diabetes mellitus, cerebrovascular and cardiovascular diseases. The patient was admitted to the emergency department with fever and abdominal pain. There was no history of diarrhea or use of antibiotics. Laboratory parameters revealed signs of inflammation and elevated AST and ALT levels. Abdominal ultrasound and computer tomography showed multiple focal lesions in the bilateral liver lobes and hydropic gallbladder with stones. The patient underwent cholecystectomy and the liver abscesses were drained. Toxigenic C. difficile strains were isolated from the drained pus and also from the stool sample. According to repetitive-element PCR (rep-PCR) analyses both organisms were the same. The organisms were susceptible to antibiotics. Despite proper antibiotic therapy and surgical drainage, the patient succumbed to her illness.

Pyogenic liver abscess in a child with concomitant infections –Staphylococcus aureus, Echinococcus multilocularisandMycobacterium tuberculosis

SummaryPyogenic liver abscess is an uncommon but important and potentially life-threatening disease that occurs whenever there is failure of clearance of an infection in the liver. Work presents a rare case of pyogenic liver abscess with confirmed bacterial aetiology ofStaphylococcus aureus, subsequently confirmedEchinococcus multilocularisand suspectedMycobacterium tuberculosisliver infection in 6 years old child. Moreover, several other parasitic diseases were recorded. According to clinical presentation of diseases, it could be supposed that liver impairment caused by alveolar echinococcosis and potentially also byM. tuberculosiscould be the predisposition site for the capture ofStaphylococcus aureusin altered liver tissues during its haematogenous spreading, and thus contributed to the development and subsequent clinical presentation of pyogenic liver abscess. The presence of three different aetiological agents complicated the diagnostic process as well as the therapy of the patient and made her prognosis uncertain. Proper diagnosis of multiloculated liver abscesses, with echinococcosis and hepatic tuberculosis considered in the differential diagnosis, is therefore crucial to administration of early and appropriate treatment.