Cause Of Liver Abscess Research Articles

Management of Dubayla al-Kabid (Liver abscess) in Unani medicine: A review

Dubayla al-Kabid (Liver abscess) is a condition in which collection of pus occurs in the liver commonly involving the right lobe. Traditional Unani medicine offers a detailed description of liver disorders alongwith their management. Causative factors of Dubayla al-Kabid include- infection, chronic dysentery, liver injury, cholelithiasis, irregular diets etc. The symptoms are fever with chills, abdominal pain, loss of appetite and difficulty in breathing. The line of treatment under Usool-e-Ilaj of the disease is based on evacuation of pus, use of medicines with Dāfi‘-i-Ḥummā (Antipyretic) , Daf‘-i-Ta‘affun (Antiseptic), Muḥāfiẓ-i-Jigar (Hepatoprotective) and Muqawwī-i-Jigar(Liver tonic) properties. In contemporary medicine liver abscess is an encapsulated collection of suppurated material within the liver resulting from either fungal, bacterial, or parasitic infection. Although Klebsiella pneumoniae accounts for 50–70% of cases in the Asian subcontinent, Entamoeba histolytica is also frequently seen in routine clinical practice causing liver abscesses. Escherichia coli is the most common bacterium causing liver abscesses. Thus, infection that spreads throughout the biliary system is one of the most frequent causes of liver abscess requiring antibiotics. The drainage of pus is the treatment of choice in cases of large abscess while small liver abscess of 2-3 cm is conventionally treated with antibiotics. Antimicrobial resistance and persistence are associated with an elevated risk of treatment failure and relapsing infections. Hence there is a need to explore the ages old treatment strategies for the management of small liver abscess laid down in traditional Unani medicine. This paper will further pave the way of developing novel therapies for the effective management of liver abscess. Keywords: Dubayla al-Kabid, Unani management, Usool-e-Ilaj

A91 PYOGENIC LIVER ABSCESSES DUE TO FUSOBACTERIUM NUCLEATUM ARE ASSOCIATED WITH SEVERE INFLAMMATORY RESPONSE AND ACUTE LIVER FAILURE: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background Pyogenic liver abscesses (PLAs) are uncommon entities with potentially devastating consequences requiring early diagnosis and treatment. Fusobacterium nucleatum is an anaerobic, gram-negative bacterium that is a rare cause of liver abscesses. F. nucleatum initiates a severe pro-inflammatory cascade that promotes abscess formation through the gut-liver axis especially when the gastrointestinal (GI) barrier is compromised. Aims In this study, we explore the characteristics of PLAs due to F.nucleatum, including the duration and mode of therapy. This may inform clinical decisions when treating persons with suspected F.nucleatum PLAs and improve mortality. Methods A systematic literature search was conducted in MEDLINE, PubMed, and the Cochrane Library, from 1977 to September 2023. We included full-text abstracts and articles written in English that reported patients with F.nucleatum PLA aged ampersand:003E18. Demographics, history of GI diseases, pertinent laboratory markers, abscess characteristics, and the approaches taken to treat the abscess were collected. Pooled data were assessed qualitatively and reported as mean±SEM when appropriate. Results We included 32 studies. The mean patient age was 52±20 years with 71% being male. In total, 47% of patients had a recent history of GI disease: sigmoid diverticulosis (n=6), colonic adenomas (n=5), duodenitis (n=2), appendicitis (n=1) and ulcerative colitis (n=1). On presentation, only 53% (n=17) reported abdominal pain. Labs were significant for leukocytosis at 22±2 K/µL, C-reactive protein 199±37 mg/L, aspartate transferase (AST) 128±24 U/L, alanine aminotransferase (ALT) 116±16 U/L, Alkaline phosphatase (ALP) 275±35 IU/L, and bilirubin 11±3 mg/dL suggestive of severe inflammatory response and cholestatic liver injury. The average abscess size was approximately 10.2±0.7 cm, 28% of which had loculations (n=9) requiring multiple drainages (n=7) or laparoscopy (n=2). The initial antibiotic of choice was piperacillin/tazobactam (Zosyn) (n=12), ceftriaxone + metronidazole (n=7), Ampicillin/Sulbactam (Unasyn) (n=5), followed by Meropenem, Metronidazole, and Ciprofloxacin. The estimated length of stay was 23±4 days with a need for long-term antibiotic therapy (54±10 days) upon discharge. The majority of patients were discharged on Metronidazole (n=11), or Amoxicillin/Clavulanic acid (Augmentin) (n=6). With appropriate source control, the estimated survival was 91% (n=29). Conclusions Our findings suggest that PLAs due to F.nucleatum are associated with large abscesses, a severe inflammatory response, cholestatic liver injury, and prolonged hospitalization. Multiple drainages with targeted gram-negative coverage may be required for adequate source control and favorable outcomes. Funding Agencies None

Genotypic And Phenotypic Surveillance Of Multidrug Resistance Of Hypermucoid K. Pneumoniae Among Clinical Isolates In AL Najaf City /Iraq

Hypervirulent Klebsiella pneumoniae strains are the major cause of liver abscesses ,diabetes foot ulcers and other infections throughout Iraq, and these strains are usually antibiotics susceptible. Recently, hypervirulent K. pneumoniae isolates have emerged due to acquiring antimicrobial resistance determinants or the transfer of a virulence plasmid into a classic isolates ,.Klebsiella pneumoniae is responsible for hospital- and community-acquired infections. This study aimed to determine the prevalence of hyper irulence K. pneumoniae and investigate the antibiotics resistance profile among clinical specimens at Al Najaf Hospitals in/ Iraq, and detect the genes for molecular identification of K. pneumoniae in comparison with phenotypic and biochemical methods. In total, 100 clinical specimens were collected from patients infected with K. pneumoniae, between January 2023 and May 2023 from both sexes males (38) and Females (62) with age ranged between (20-70) years. The Hypervirulent Klebsiella pneumoniae isolates were cultured on general and selective media as (Blood agar and MacConkey agar and CHROM agar), and confirmed by using Vitek-2 system. The isolates were reported with high resistance towards various types of antibiotics, especially penicillins and cephalosporins. In contrast, K. pneumoniae showed very low resistance to imipenem and amikacin. According to the results the range of multidrug-resistant K. pneumoniae isolates in this study was estimated at 100%.

Profile of Amoebic vs Pyogenic Liver Abscess and Comparison of Demographical, Clinical, and Laboratory Profiles of these Patients From a Tertiary Care Center in Northern India

Amoebic liver abscess (ALA) and pyogenic liver abscesses (PLA) are the most common causes of liver abscess in developing and developed countries, respectively. Although incidence of liver abscess is low, but mortality is high amongst the patients due to delayed diagnosis. The study was done to find out the prevalence of amoebic and PLA among patients of liver abscess. The clinical, personal, and demographical details were also evaluated to find out the risk factor(s) associated with ALA and PLA, respectively. A retrospective study was conducted to find the prevalence of amoebic and PLA. Clinical, demographic, personal details were evaluated from hospital records. Laboratory parameters such as total leucocyte count, platelets, bilirubin, ESR (Erythrocyte Sedimentation Rate), hemoglobin, glycosylated hemoglobin (HbA1c), alkaline phosphate (ALP), Aspartate aminotransferase (SGOT/AST), Alanine aminotransferase (SGPT/ALT), serum albumin, bilirubin levels, and procalcitonin were recorded. The Ultrasonography (USG) findings regarding the size, location, volume, and number of abscesses were also analyzed. Total of 107 patients of liver abscess were evaluated, and 61.6% of patients were of amoebic etiology, and 25.3% were of pyogenic etiology. Males of 20-60 years of age were predominantly affected with right upper quadrant pain and fever as the most common presentations. ALA patients were found to have solitary abscess in the right lobe involving 6th and 7th segments, with decreased hemoglobin, hyperbilirubinemia, elevated ALP and SGOT, with normal SGPT, and addiction to alcohol. PLA patients had increased HbA1c, increased PCT values, low serum albumin levels, and low platelet-to-white blood cellvalues. The most common bacteria causing PLA was Escherichia coli (n= 8) followed by Enterobacter cloacae (n= 5). Mortality was seen in 6 patients. Liver abscess is found to have relatively high mortality and morbidity. Therefore, early diagnosis is the only method to prevent mortality and morbidity in these patients. Since the presentation is very nonspecific, evaluation of certain risk factors and laboratory parameters can aid in the diagnosis.

Hepatic Abscess in Adults: Integrated Approach and Surgical Considerations

Hepatic abscesses are suppurated cavities caused by the invasion and multiplication of microorganisms within the liver parenchyma. This condition is relatively uncommon, with an estimated incidence of 2.3 to 3.6 cases per 100,000 people yearly. However, the incidence is higher in specific populations, such as patients with underlying liver disease, diabetes, or other immune-compromising conditions. The most common cause of liver abscesses is the spread of infection from other parts of the body, such as the biliary tract or gastrointestinal tract. Other causes include trauma to the liver, such as from a penetrating injury or surgery or the presence of a foreign body in the liver. Liver abscesses are broadly divided into two types: amoebic and pyogenic. The clinical presentation might vary, including fever, abdominal pain, nausea and vomiting, jaundice, and weight loss. In some cases, there may be no symptoms. Diagnosis typically involves an ultrasound or CT scan, which can show the presence of a fluid-filled mass in the liver. CT is the standard modality for diagnosis. Blood tests may also evaluate liver function and identify any underlying infections. Treatment typically involves a combination of antibiotics to target the underlying infection and drainage of the abscess. Supportive measures like hydration and pain management may also be necessary. In addition, close monitoring and follow-up are essential to ensure that the abscess has resolved and there are no complications. In some cases, surgical intervention may be necessary to remove the abscess or repair any damage to the liver. Liver abscess drainage is typically indicated in patients with significant, symptomatic abscesses or those who do not respond to medical treatment with antibiotics. In addition, abscesses at risk of rupturing or located close to vital structures, such as major blood vessels, may require drainage to prevent serious complications. Two drainage methods are presently available: non-surgical options, such as percutaneous needle aspiration or percutaneous catheter drainage, and surgical options, such as open drainage or laparoscopic drainage. This review identifies when these alternatives should be used, taking adverse effects, symptoms, and comorbidities into account.

A prospective observational study of demographic profile in patients of amoebic and pyogenic liver abscesses in a tertiary care hospital

Background: Liver abscesses, both amoebic and pyogenic, continue to be an important cause of morbidity and mortality in tropical countries. Pyogenic liver abscess is a serious, life-threatening condition with a high mortality rate that represents a diagnostic and therapeutic challenge. In India, due to poor sanitary condition and a lower socioeconomic status, amoebiasis is endemic and amoebic liver abscess accounts for 3-9% of all cases of amoebiasis. Aim and objectives of current study was to study demographic profile in patients of amoebic and pyogenic liver abscesses. Methods: A detailed history was taken from each of these patients and all of them were subjected to a through clinical examination. Results: The highest incidence occurred in the age group 31-50 years; males were more commonly affected than females. Fever and pain abdomen were the most consistently occurring symptoms. All the patients with liver abscess had abdominal tenderness. 17 patients (74%) with liver abscess were alcoholics. 8 patients (80%) with amoebic liver abscess were alcoholic as compared to 9 patients (69%) in pyogenic liver abscess. Conclusions: Pyogenic organisms were most common cause of liver abscess.

S3648 Pyogenic Liver Abscess: Where Did It Come From, How Did It Grow?

Introduction: Liver abscesses are suppurative space occupying lesions resulting from the invasion of the liver tissue by insult/injury, intraabdominal infection disseminated from the portal venous circulation, or originate in the biliary system. Three different etiologies consist of pyogenic, amebic and fungal abscesses. The common cause of liver abscess in the United States is bacterial intraabdominal source. Additionally, the right lobe of liver is mostly an affected region as it’s predominately supplied by superior mesenteric vein. We describe an unusual case of right hepatic lobe abscess with unidentifiable source. Case Description/Methods: We present a 79-year-old woman with a medical history of diabetes and hypertension who presented with complaint of fatigue. She otherwise denied recent illness, travel, hospitalizations or intestinal infections. On presentation, she was hypotensive and admission labs significant for neutrophil predominant leukocytosis. The patient exhibited right upper quadrant tenderness. Blood cultures were obtained. Broad spectrum antibiotics were started. Pertinent imaging revealed a hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver. Interventional radiology performed a biopsy and aspiration of 60 mL purulent fluid. Blood cultures grew Bacteriodes fragilis. Surgical liver pathology was predominately fragments of necrotic hepatic tissue with acute inflammation. Liver abscess cultures speciated Escherichia coli, Klebsiella pneumonia, and Streptococcus intermedius. Antibiotics were tailored accordingly. This prompted an echocardiogram which was negative for valvular vegetations. The patient opted for outpatient colonoscopy for further evaluation. Repeat liver imaging showed enlarging abscess, therefore drain was placed. Patient was sent home on 6 week course of antibiotics. Discussion: While the incidence of liver abscess is low, it is essential to have a complete understanding of the disease activity and harm potential because the severity of these abscesses have a high mortality if left untreated. The physiology of disease is so delicate in these patients that an abscess located in the liver parenchyma close to the diaphragm can cause referred pain to the right shoulder or potentially a cough caused by diaphragmatic irritation. Although imaging was negative for etiology of the abscess, the workup is still in progress. This case highlights the importance of antibiotic therapy with drain placement to achieve source control and clinical and bacteriologic cure.Figure 1.: CT imaging demonstrating hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver.

Liver Abscess: Complications and Treatment.

Liver Abscess: Complications and Treatment.

A clinical study of liver abscess in patients attending the surgical department. A single center experience.

Liver abscess is a condition that is seen by surgeons all over the world. The patients present to the surgical department with features of right hypocondrial pain, fever and jaundice. Investigations such as ultrasound of the abdomen and CT scan of the abdomen are extremely useful in diagnosing a case of liver abscess. The two main causes of liver abscess are amoebic and pyogenic liver abscess. Occasionally a liver abscess may also occur due to fungal infection. Treatment modalities include the use of drugs such as metronidazole for amoebic liver abscess, as well as needle aspiration and pigtail catheter drainage when required. This was a prospective study was carried out from August 2015 to July 2018, for a period of three years. The study was conducted at SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu, India. Investigations such as complete blood count (CBC), chest x-ray, x-ray abdomen, ultrasound of the abdomen and CECT of the abdomen were done. A total of 57 patients were studied and the results obtained were analysed.

S2662 An Unexpected Cause of Refractory Liver Abscesses

INTRODUCTION: We report a case of multifocal liver abscesses with recurrent fevers refractory to prolonged antibiotic therapy and catheter drainage due to penetration of a toothpick into the portal vein. CASE DESCRIPTION/METHODS: A 72-year-old male with type II diabetes presented with fever, confusion, and right upper quadrant pain associated with malaise and unintentional weight loss. Objective findings were consistent with septic shock and acute liver injury. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) showed a 6.9 × 8.0 × 5. hepatic abscess and several scattered fluid collections (Figure 1). Immediate broad-spectrum antibiotics and percutaneous catheter drainage resulted in clinical improvement. Abscess fluid and blood cultures grew actinomyces odontolyticus and streptococcus viridans, respectively. Amebic serology was negative. Transition to appropriate outpatient antibiotics resulted in two readmissions for recurrent fevers with persistent drainage output for weeks. A repeat CT showed a shrunken abscess and a 4.6 cm radio-opaque linear foreign body penetrating through the gastric antrum into a branch of the left portal vein (Figure 2). Review of previous imaging confirmed the foreign body was present since first admission. Upper endoscopy showed a patch of erythematous mucosa in the antrum encircling a pinpoint opening to a fistulous tract and exuding purulent fluid (Figure 3). Exploratory laparotomy revealed a 4.5 cm wooden toothpick in the portal vein surrounded by a dense fibrotic scar. Foreign body removal and porto-enteric fistula repair were performed. Follow up CT showed complete resolution of the abscess. DISCUSSION: Penetrating foreign body is a rare cause of liver abscess. To our knowledge, penetration of a foreign body into the portal vein resulting in liver abscesses has never been reported. Discovery of foreign body requires a high index of suspicion as patients rarely remember ingesting the object, and it can be easily missed on CT. When suspected, a non-contrast CT is recommended with attention to coronal/sagittal views with signs such as thickened antral wall and fistulous tract. Non-specific clinical features such as hematemesis, subacute/chronic abdominal pain, and failure of antibiotic therapy can be suggestive. In the setting of any of these findings, foreign body should be considered in patients with unexplained liver abscess.Figure 1.: A large dominant hepatic abscess measuring 6.9 × 8.0 × 5.3cm, involving segments 4A and 4B of the liver, extending to and involving the anterior wall of the gallbladder, as well as several scattered small fluid collections (MRI of liver without contrast).Figure 2.: A 4.6cm radio-opaque linear foreign body penetrating through the gastric antrum into a branch of the left portal vein (CT of abdomen and pelvis without contrast).Figure 3.: A patch of erythematous mucosa in the pre-pyloric antrum encircling a pinpoint opening to a fistulous tract and scant purulent liquid; the foreign body was not visible (upper endoscopy).

Abiotrophia defectiva liver abscess in a teenage boy after a supposedly mild blunt abdominal trauma: a case report

BackgroundA pyogenic liver abscess (PLA) represents a pus-filled cavity within the liver parenchyma caused by the invasion and multiplication of bacteria. The most common offender isolated from the PLA in children is Staphylococcus aureus. Abiotrophia defectiva is a Gram-positive pleomorphic bacterium, commonly found in the oral cavity, intestinal, and genitourinary mucosa as part of the normal microbiota. It has been proven to be an etiological factor in various infections, but rarely in cases of PLA. The case presented here is, to the best of our knowledge, the first pediatric case of PLA caused by A. defectiva.Case presentationA 13-year-old Caucasian boy presented with a two-day history of abdominal pain, fever up to 40 °C, and polyuria. Contrast-enhanced computed tomography (CT) scan revealed a single, multiloculated liver lesion, suggestive of a liver abscess. The boy had sustained a bicycle handlebar injury to his upper abdomen 3 weeks before the symptoms appeared and had been completely asymptomatic until 2 days before admission. He was successfully treated with antibiotic therapy and open surgical drainage. A. defectiva was isolated from the abscess material. Histopathology report described the lesion as a chronic PLA.ConclusionsA. defectiva is a highly uncommon cause of liver abscess in children. In such cases, various predisposing factors should be considered, including antecedent blunt abdominal trauma.

Current Status of Amebic Liver Abscess in Korea Comparing with Pyogenic Liver Abscess.

With the improvement of hygiene, the incidence of amebic liver abscess is decreasing in South Korea. On the other hand, there is little data on the status of amebic liver abscess compared to pyogenic liver abscess. Patients with an amebic liver abscess, in whom Entamoeba histolytica (E. histolytica) IgG was positive, were identified retrospectively in a university hospital. The clinical, laboratory, and radiological characteristics of amebic liver abscess were compared with those of pyogenic liver abscess in the same period. Between March 2010 and October 2016, 413 patients with a liver abscess were identified. Among them, the serologic test for E. histolytica was performed in 209 patients. Fifteen (7.2%) were classified as an amebic liver abscess, and the remainder were diagnosed with a pyogenic liver abscess. The age, gender, white blood cell, and CRP was comparable between the two groups. Procalcitonin was lower in amebic liver abscess than the pyogenic one. On CT, peripheral rim enhancement was more frequent, but cluster signs were not observed in amebic liver abscess compared to pyogenic liver abscess. None of the patients with amebic liver abscess died. In contrast, the mortality of pyogenic liver abscess was 4.7%. Amebic liver abscess should still be considered as one of the causes of liver abscess in Korea. It is difficult to discriminate an amebic liver abscess from a pyogenic liver abscess only according to the clinical, laboratory, and radiologic findings. Therefore, it is necessary to perform a serologic test for E. histolytica for a precise evaluation of liver abscess in a high-risk group.

Liver abscess caused by fish bone perforation of Meckel\u2019s diverticulum: a case report

BackgroundLiver abscess due to gastrointestinal perforation by foreign bodies is rare. Furthermore, there are few case reports of liver abscess via the portal vein caused by perforation of the lower gastrointestinal tract by a foreign body.Case presentationA 54-year-old man visited our hospital because of a fever that had lasted for 1 month. There were no physical findings except for the fever. Laboratory tests showed only elevated inflammatory markers. Abdominal contrast-enhanced computed tomography revealed an abscess in the right lobe of the liver and a high-density object in the small intestine. We diagnosed him with liver abscess secondary to intestinal perforation by a foreign body. The patient underwent drainage of the liver abscess and laparoscopic surgery for perforation of the small intestine. A fish bone had perforated the top of Meckel’s diverticulum, which had been covered by the ileal mesentery. We successfully performed diverticulectomy and removed the fish bone. The patient was discharged without complications on the 13th postoperative day.ConclusionsLiver abscess caused by foreign bodies requires multidisciplinary treatment, so we must detect and remove the cause of the abscess earlier. Liver abscess can form via the portal vein secondary to lower gastrointestinal perforation, as in this case. When exploring the cause of liver abscess, we should investigate the whole body, including the lower gastrointestinal tract.

Exceptional source of liver abscess: 3 cases of oropharynx origin

Background: Pyogenic liver abscess is a rare entity, it is fatal when untreated. Its approach has been improved due to percutaneous drainage and better microbiological characterization. In our environment, the most common pathogens are Enterobacteriaceae. Our aim is to present 3 cases of liver abscess caused by unusual microorganisms, habitual commensals of the oropharynx. Material & Methods: Two men and a women was admitted to emergency service with a story of fever (>38.5ºC). Case 1: A 64-year-old man without other sintoms. US and CT scan was performed, showed focal subcapsular lesion in the VII-VI segment, hypoechoic with hyperechogenic areas suggestive of abscess. Abscess drainage was performed and positive culture was obtained for Haemophilus parainfluenzae. Case 2: A 57-year-old woman mujer de 57 with jaundice and coluria. CT scan reported multiple hepatic abscesses. Abscess drainage was performed with positive culture for Streptococcus intermedium. The orthopantomography study showed radicular remnants of 36 and 46, both with implants. Case 3: A 61-year-old man with abdominal pain. CT showed heterogeneous mass in liver segments VII and VIII with small cystic areas inside. Abscess drainage was performed with positive culture for Streptococcus intermedium. Orthopantomography showed septic foci associated with implants. Results: All three patients were admitted with antibiotic treatment and radiologic drainage. In two of them (cases 1 and 3) antibiotic treatment was not enough, therefore surgery was performed; while in case 2 the antibiotic treatment was adequate. In addition, cases 2 and 3 received surgical treatment by maxillofacial surgery to extract the dental pieces. Currently, patients are asymptomatic. Conclusions: Haemophilus parainfluenzae and Streptococcus intermedium are a uncommon cause of liver abscess. Without treatment, the mortality of the liver abscess is 100%. Early diagnosis and correctly isolate the pathogens are essential even more when we face something uncommon.

Atypical Presentation for Colorectal Cancer

Bowel cancer is the second most common non-cutaneous cancer diagnosed in Australia in both the sexes. Australia has one of the highest incidence of bowel cancer in the world. Pyogenic liver abscess has been reported to be associated with malignancy especially hepatobiliary and colorectal cancer. A healthy 70 years old woman presented with non-specific symptoms which was initially thought to be secondary to haematological malignancy. Further investigation noted multiple large cystic and solid hepatic masses, which were suggestive of metastasis. However, hepatic lesions responded significantly with antibiotics which was in keeping with liver abscess instead. She was subsequently confirmed to have caecal adenocarcinoma with no distant metastasis. Although uncommon, pyogenic liver abscess can be the first presentation for colorectal malignancy. Colonoscopy is essential especially if no clear cause of liver abscess is identified.

An ununsual cause of liver abscess in western countries

Background: Liver abscess for Ascaris lumbricoides is rare, accounting for 1% of all cases. It usually has a good response to conservative treatment with oral antihelmintics; however, the diagnosis in non-endemic areas can be very difficult. We present a case diagnosed following percutaneous drainage. Methods: A 60 year old male patient was admitted to our hospital with abdominal pain and high temperature. He previously underwent an endoscopic sphinterotomy for acute biliary pancreatitis. Liver ultrasound showed a 18 cm liver abscess. Results: The patient was submitted to percutaneous drainage, obtaining biliary content mixed with fragments dead ascarides. Diagnosis of Ascariasis was made and treatment with Albendazole was started with good outcome. Conclusion: Ascaris lumbricoides migrates through the biliary tree and it can occasionally be responsible for liver abscess even in non-endemic areas. This might have been facilitated by thr previous endoscopic sphyncterotomy.

An ununsual cause of liver abscess in western countries

An ununsual cause of liver abscess in western countries

Keeping an Eye Out for Klebsiella Endopthalmitis: Klebsiella Pneumoniae Invasive Liver Abscess Syndrome

Hypervirulent Klebsiella pneumoniae strain is a major cause of liver abscess and this bacteria has metastatic properties. This distinct liver abscess syndrome has been increasingly reported in Asia over the past two decades, but is emerging as a global disease. We described an 81-year-old lady, who presented to the emergency department with 1-week prior duration of fever and right eye swelling. She had been admitted for recurrent liver abscess prior to this. Hence, she was initially treated as sepsis secondary to recurrent liver abscess. Meanwhile, she was managed concurrently by ophthalmology team for endophtalmitis. Despite the initiation of treatment with antibiotics, she did not show any improvement and required right eye evisceration to treat the sepsis. Invasive liver abscess syndrome with metastatic endophthalmitis should be screened in patient with Klebsiella liver abscess. They should be monitored for ocular symptoms as early recognition can prohibit delays in treatment, which has debilitating consequences.

Uncommon cause of liver abscess.

Key Clinical MessageGastrointestinal perforation by fishbone causing a liver abscess is a rare entity, but should be included in the differential diagnosis to avoid delay in the treatment.

Eikenella corrodens endocarditis and liver abscess in a previously healthy male, a case report

BackgroundEikenella corrodens is one of the HACEK bacteria constituting part of the normal flora of the oropharynx, however, still an uncommon pathogen. We report a case of a large Eikenella corrodens liver abscess with simultaneously endocarditis in a previously healthy male.Case presentationA 49-year-old Danish man was admitted because of one-month malaise, fever, cough and unintentional weight loss. On admission there was elevated white blood cell count and C-reactive protein, as well as affected liver function tests. Initially pneumonia was suspected, but due to lack of improvement on pneumonia treatment, a PET-CT scan was performed, which showed a large multiloculated abscess in the liver. The abscess was drained using ultrasound guidance. Culture demonstrated Eikenella corrodens. Transesophageal echocardiography revealed aortic endocarditis. The patient was treated with antibiotics and abscess drainage, on which he slowly improved. He was discharged after 1.5 months of hospitalisation. On follow-up 2 months later, the patient was asymptomatic with normalized biochemistry and ultrasound showed complete regression of the abscess.ConclusionsThis is the first case of documented Eikenella corrodens concurrent liver abscess and endocarditis. The case report highlights that Eikenella corrodens should be considered as a cause of liver abscess. Empirical treatment of pyogenic liver abscess will most often cover Eikenella corrodens, but the recommended treatment is a third generation cephalosporin or a fluoroquinolon. A multiloculated liver abscess may require drainage several times during treatment. The finding of Eikenella corrodens should elicit an echocardiography to diagnose endocarditis even in patients without clinical signs of endocarditis.