Case Of Liver Abscess Research Articles

P-773. Mycobacterium Tuberculosis Liver Abscess in Kidney Transplant Recipients

Abstract Background Recipients of solid organ transplant (SOT) have higher risk for infections, and the prevalence of mycobacterium tuberculosis liver abscess (MTB-LA) without pulmonary/disseminated MTB is 0.34%. However, there is little research on MTB-LA in SOT recipients. Mycobacterium tuberculosis Liver Abscess Cases Upon extensive literature review, this chart details all published, English-language cases of mycobacterium tuberculosis liver abscess in solid organ transplant recipients. Methods We conducted an extensive literature review of MTB-LA in adult SOT recipients. Results Our review showed 4 cases of MTB-LA in SOT recipients (table below). We detail 1 additional case. A 58-year-old male with ESRD due to type 2 diabetes mellitus, and latent MTB underwent kidney transplantation in March 2023. He completed a 6-month course of isoniazid and vitamin B6 for latent MTB 1 month before transplant. His post-operative course was uncomplicated; he was discharged to follow up with his nephrologist. He later developed norovirus illness with fever, which was conservatively managed. He developed new fevers 3 months post-transplant and CT of the abdomen/pelvis revealed a liver abscess, which was treated with empiric broad spectrum antibiotics, and was not amenable to aspiration. At his 4-month post-transplantation, he complained of fatigue, night sweats, poor appetite, and weight loss requiring hospitalization, wherein an MRI of the abdomen/pelvis identified a 3.6 x 3.2 x 6.2 cm liver abscess. The liver abscess aspirate was positive on acid fast bacilli smear and MTB polymerase chain reaction. He was initiated on antituberculosis therapy with isoniazid, rifabutin, pyrazinamide, and ethambutol. Susceptibilities identified pyrazinamide resistance, and led to substitution with levofloxacin. Labs, imaging and microbiology testing were negative for evidence of pulmonary/disseminated MTB. His donor’s information was reviewed; no obvious risk factors for active MTB were found. The recipient of the mate kidney is doing well without evidence of MTB infection. After 2 months of 4-drug antituberculosis therapy, ethambutol was discontinued. CT scan of the abdomen and pelvis at 4 months post anti-tuberculosus therapy revealed a 3 cm area of residual inflammation at the site of prior MTB-LA, in the setting of resolution of prior symptoms. Conclusion Early imaging and diagnostic aspiration of liver abscess with specific stains, culture and PCR testing can facilitate rapid diagnosis and initiation of antituberculosis therapy. Disclosures All Authors: No reported disclosures

Disseminated organ and tissue infection secondary to carbapenem-resistant Klebsiella pneumoniae bloodstream infection for acute lymphoblastic leukemia treated with ceftazidime-avibactam: Two case reports.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections are a severe complication resulting from granulocyte deficiency following chemotherapy for hematologic malignancies and have a high mortality rate. However, reports of disseminated organ infections secondary to bloodstream infections are rare. We report 2 cases of patients with acute lymphoblastic leukemia who both developed CRKP bloodstream infections during the granulocyte deficiency stage following chemotherapy, with 1 case of secondary bacterial liver abscess and 1 case of secondary septic arthritis. Based on the results of drug sensitivity testing, both patients were treated with ceftazidime-avibactam, and the infections were rapidly and effectively controlled without significant adverse effects. Ceftazidime-avibactam exhibited satisfactory efficacy and safety in the 2 cases of disseminated organ infection secondary to CRKP bloodstream infection following chemotherapy for acute lymphoblastic leukemia.

Bacteriological Etiology of Empyema Thoracis Patients Admitted in a Tertiary Care Hospital

Empyema thoracis is the most common complication of pneumonia and is associated with severe morbidity and mortality. Management of empyema thoracis is complex and needs a multimodal approach. Antibiotic therapy is very crucial in management of empyema thoracis and epidemiological data is essential to ensure appropriate antibiotic therapy. This study aimed to explore the bacteriological profile of empyema thoracis in a tertiary care hospital. This cross-sectional study was carried on 30 patients admitted in the Department of Medicine and Department of Respiratory Medicine, Sir Salimullah Medical College and Mitford Hospital (SSMC & MH), Dhaka over a period of six months (March to September 2021). Mean age of the patients was 38±10.94 (SD) years and male–female ratio was 2:1 (66.7% male). The most common symptoms were found cough (86.7%) and fever (83.3%) including major presenting symptoms expectoration (76.7%) and chest pain (70.0%); other symptoms were loss of appetite (50.0%), malaise (46.7%) and hemoptysis (10.0%). The major etiology was the thoracic empyema (56.7%) followed by pneumonia (16.67%), lung abscess (10.0%), liver abscess (6.7%), lung cancer (3.3%), secondary infection (3.3%) and undetermined cases responding to antibiotics (3.3%). Bacteriological profile showed that majority of the cases (56.7%) were Mycobacterium Tuberculosis; others cases were S. aureus (6.7%), S. pyogen (6.7%), E. coli (3.3%), Klebsiella (3.3%) and Pseudomonas (6.7%). It was concluded from the study, more than half of empyema thoracis was etiologically tubercular. Bangladesh Med J. 2023 Sept; 52(3): 27-34

Summary of clinical features of 1800 cases of pyogenic liver abscess.

This study aimed to summarize the clinical and microbiological characteristics of patients with pyogenic liver abscess (PLA) and to explore the clinical features of PLA with extrahepatic migratory infection (EMI). A retrospective analysis was conducted on clinical data from 1800 PLA patients at Jilin University First Hospital from January 2019 to December 2023. Patients were divided into two groups based on the presence of EMI: with EMI and without EMI. Clinical features and prognoses of the two groups were compared using rank-sum tests and chi-square tests for continuous and categorical data, respectively. PLA patients were predominantly male (65.56%) with an average age of 60. Abscesses were mainly located in the right lobe (64.83%) and were often single (68.17%). Klebsiella pneumoniae was the primary pathogen (68.46%), with 9.50% of strains being multidrug-resistant. The majority of patients improved with effective treatment (96.17%). Compared with the non-EMI group, patients with EMI were younger, had longer hospital stays, smaller abscesses, and a higher incidence of diabetes and cerebrovascular disease, with poorer prognoses. PLA is most commonly observed in middle-aged and elderly males, often presenting as single abscesses in the right lobe, with diabetes as a frequent underlying condition. Most patients recover with appropriate antibiotic treatment and ultrasound-guided drainage. PLA patients with EMI generally have poorer outcomes and require special attention.

Clinical Profile of Patients Diagnosed with Liver Abscess – a Retrospective Study at a Teaching Hospital

Background: Liver abscesses continue to present a significant diagnostic and therapeutic challenge to the medical community. Early clinical distinction between an amoebic and a pyogenic liver abscess is challenging due to their overlapping clinical presentations. Aim: The present study was undertaken to evaluate the clinical characteristics, lab parameters as well as management in patients suspected of liver abscess. Methods: A retrospective study was carried out in 60 consecutive patients presenting with liver abscess, admitted at tertiary care hospital. Lab investigations were carried out. All patients underwent ultrasound-guided aspiration of a liver abscess either by percutaneous needle or by a pigtail catheter. Patients were monitored during the period of hospital stay to note their outcome. The data variables collected were compiled by using an excel spreadsheet and later analysed using Medcalc (version 20.118). Results: The commonly observed clinical presentation was abdominal pain (95%) followed by fever (57%) and jaundice (7%). On examination, 60% of the liver abscess cases had right hypochondrial tenderness while Hepatomegaly was observed in about 17% of the subjects. Leucocytosis was observed in 67% of the cases in view of underlying infectious etiology. The size of the majority (60%) of the liver abscess were in the range of 5.1 to 9.9 cms and right lobe was the most affected region (75.2%). Conclusion: Early recognition of symptoms, institution of antibiotic and amoebicidal therapy and drainage of abscess via appropriate modality improves the prognosis of liver abscess.

Pyogenic liver abscess due to Burkholderia pseudomallei in immunocompetent patient from Garhwal region of Uttarakhand – A case report

We report a case of liver abscess due to Burkholderia pseudomallei in a 45-year-old, non-diabetic patient from the Garhwal region of Uttarakhand. The patient reported chief complaints of abdominal pain and fever. Ultrasonography and contrast-enhanced computed tomography of the whole abdomen were suggestive of the left liver lobe abscess. Pus was aspirated from the abscess and sent for culture and sensitivity. Growth on the culture plate was identified as B. pseudomallei; the patient was then treated with appropriate antibiotics and discharged in stable condition. Diagnosis of pseudomallei infection requires a high index of suspicion among clinicians as well as laboratory specialists. Early identification of organisms helped clinicians initiate appropriate management in our case.

A combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound in the Kupffer phase for the diagnosis of well-differentiated hepatocellular carcinoma and atypical focal liver lesions: a prospective, multicenter study.

The objective of this study was to develop a combined model based on radiomics features of Sonazoid contrast-enhanced ultrasound (CEUS) during the Kupffer phase and to evaluate its value in differentiating well-differentiated hepatocellular carcinoma (w-HCC) from atypical benign focal liver lesions (FLLs). A total of 116 patients with preoperatively Sonazoid-CEUS confirmed w-HCC or benign FLL were selected from a prospective multiple study on the clinical application of Sonazoid in FLLs conducted from August 2020 to March 2021. According to the randomization principle, the patients were divided into a training cohort and a test cohort in a 7:3 ratio. Seventy-nine patients were used for establishing and training the radiomics model and combined model. In comparison, 37 patients were used for validating and comparing the performance of the models. The diagnostic efficacy of the models for w-HCC and atypical benign FLLs was evaluated using ROCs curves and decision curves. A combined model nomogram was created to assess its value in reducing unnecessary biopsies. Among the patients, there were 55 cases of w-HCC and 61 cases of atypical benign FLLs, including 28 cases of early liver abscess, 16 cases of atypical hepatic hemangioma, 8 cases of hepatocellular dysplastic nodules (DN), and 9 cases of focal nodular hyperplasia (FNH). The radiomics model and combined model we established had AUCs of 0.905 and 0.951, respectively, in the training cohort, and the AUCs of the two models in the test cohort were 0.826 and 0.912, respectively. The combined model outperformed the radiomics feature model significantly. Decision curve analysis demonstrated that the combined model achieved a higher net benefit within a specific threshold probability range (0.25 to 1.00). A nomogram of the combined model was developed. The combined model based on the radiomics features of Sonazoid-CEUS in the Kupffer phase showed satisfactory performance in diagnosing w-HCC and atypical benign FLLs. It can assist clinicians in timely detecting malignant FLLs and reducing unnecessary biopsies for benign diseases.

Transarterial chemoembolization using drug-eluting beads versus lipiodol in the treatment of unresectable hepatocellular carcinoma: propensity score matching.

Since the introduction of drug-eluting beads (DEB), the result comparing transarterial chemoembolization (TACE) using lipiodol, also called conventional transarterial chemoembolization (c-TACE), and DEB-TACE shows considerable controversy. The objective of this study was to compare the safety and efficacy of c-TACE and DEB-TACE to treat unresectable hepatocellular carcinoma (uHCC). This retrospective study used propensity score matching (PSM) analysis to analyze clinical data from 113 cases of primary hepatocellular carcinoma (HCC) treated at our hospital from September 2016 to July 2021. The safety and efficacy of the two treatment modalities were analyzed after 1:1 matching. The primary endpoint was progression-free survival (PFS); the secondary endpoints included overall survival (OS), disease control rates (DCRs), and objective response rates (ORRs) at 1, 3, 6, and 12 months, and postoperative complications. Twenty-nine patients underwent DEB-TACE and 84 received c-TACE; 28 pairs of patients were eventually matched. After matching, baseline characteristics between groups were comparable. The median PFS of the DEB-TACE group was 10 months compared to 6 months in the c-TACE group (P=0.002). The median OS was 23 months in the DEB-TACE group vs. 14 months in the c-TACE group, but the difference was not statistically significant (P=0.265). The ORR at 1, 3, 6, and 12 months in the DEB-TACE group (69%, 78%, 60%, and 52%) were significantly higher than those in the c-TACE group (39%, 39%, 26%, and 8%) (P<0.05). The DCR at postoperative 3 months was significantly higher in the DEB-TACE group (95%) (P<0.05). There was one case of postoperative liver abscess in the DEB-TACE group, and the patient recovered well after drainage. No serious complications occurred. Compared to c-TACE, DEB-TACE prolonged PFS and exhibited better short-term ORR with a similar level of safety. However, there was no significant advantage in terms of OS.

Liver Abscess Caused by Foreign Body

A rare case of liver abscess due to secondary bacterial infection due to foreign body penetration into stomach wall reported in this case. Presented with less severe clinical features and non-specific features of acute abdomen .Liver abscess caused by foreign body is rare. The contrast-enhanced CT (computed tomography)of the abdomen and the minimally invasive abdominal operation both played critical roles in the diagnosis and treatment of the case. The general population, who mistakenly eat fish bones, should seek medical treatment as soon as possible.

Endogenous Endophthalmitis: A 10-Year Review of Cases on the East Coast of Malaysia.

Purpose Our study aimed to describe the clinical profile of endogenous endophthalmitis, focusing on patient demographics, infection sources, microbial profiles, clinical outcomes, and factors affecting the final visual outcome. Methods A retrospective review was performed on data from 68 eyes of 60 patients diagnosed with endogenous endophthalmitis and hospitalized in two tertiary hospitals on the East Coast of Peninsular Malaysia from January 2011 to December 2020. The analysis encompassed evaluating patient age, gender, laterality, risk factors, infection origins, presenting and final visual acuity, microbial results, treatment responses, and factors affecting final visual outcomes. Results The average age of the patient cohort was 54.9 ± 13.3 years. Females were more likely to have endogenous endophthalmitis than males (33, 55.0% vs. 27, 45.0%). Twenty-seven patients (45.0%) presented with endogenous endophthalmitis in the left eye, while 25 patients (41.7%) had it in the right eye, and eight patients (13.3%) had bilateral involvement. Most patients had underlying predisposing conditions, predominantly diabetes mellitus (53, 88.3%). Infection sources were identified in 42 patients (70.0%), out of which urinary tract infections account for the majority (11, 18.3%). Klebsiella species(14, 22.7%) were the leading pathogens and were significantly associated with liver abscess cases. In this series, the majority of patients had poor presenting and final visual acuity of worse than 3/60 (56, 82.4% and 53, 77.9%, respectively). Thirty-six eyes (52.9%) underwent vitrectomy, resulting in only four eyes (11.11%) achieving final visual acuity better than 6/12. Presenting visual acuity was identified as the factor contributing to the blind final visual outcome (r = 0.707, p < 0.001). Conclusion Females were found to be more commonly affected by endogenous endophthalmitis than males. Klebsiella species were the most commonly isolated microorganisms and were typically associated with liver abscesses. Urinary tract infection was the most common predisposing factor. A majority of the patients had poor presenting and final visual acuity, in which poor visual acuity is a significant indicator of blind visual outcomes.

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.

Clinical Profile in Patients of Amoebic Liver Abscess with and without Hyperbilirubinemia: A Prospective Cohort Study

Introduction: In tropical countries like India, two-thirds of liver abscess cases are amoebic. Along with abdominal pain, fever, and other non-specific clinical features, jaundice is commonly observed in Amoebic Liver Abscess (ALA) cases. However, the understanding of jaundice in a patients with ALA is limited, and it is associated with a poor prognosis. Aim: To compare the morbidity and mortality of ALA patients with and without hyperbilirubinemia, as well as their clinical outcomes. Materials and Methods: The present prospective cohort study was conducted at a tertiary teaching institute in northern India. It included 150 patients aged between 20 and 60 years with a confirmed diagnosis of ALA. The patients were divided into two groups based on the presence or absence of hyperbilirubinemia. Those with jaundice resulting from other causes or a history of hepatitis were excluded. Variables examined in the study included age, sex, alcohol intake, basic laboratory parameters, ultrasound-assessed abscess size and number, and duration of hospital stay. Results: Among the 150 cases, 22 (14.6%) had elevated serum bilirubin levels (&gt;1 mg/dL). Additionally, 122 (81.33%) had a history of alcohol intake, and 117 (78%) had a single abscess cavity. In ALA patients with hyperbilirubinemia, 12 (54.55%) had abnormal creatinine values, and 6 (27.26%) experienced complications such as rupture and peritonitis. One mortality occurred in a patient with ALA and jaundice. Conclusion: ALA patients with jaundice exhibited larger abscess cavities, a higher complication rates, a longer hospital stays, and a poor prognoses.

A Case of Infected Aortic Aneurysm and Multiple Liver Abscesses Due to Early Sepsis after Robot-Assisted Rectal Resection

A Case of Infected Aortic Aneurysm and Multiple Liver Abscesses Due to Early Sepsis after Robot-Assisted Rectal Resection

An Unusual Case of Liver Abscess Caused by Trematodes

Liver abscess caused by trematodes is considered highly unusual. Here we present a case of an elderly female with no knowncomorbidities, who presented with fever and right upper quadrant pain. Upon evaluation, she was found to have features ofliver abscess on abdominal ultrasound and 640-slice computed tomography (CT) of the abdomen. Ultrasound-guided needlebiopsy of the liver showed features of trematode. Patient was treated with oral nitazoxanide. Patient’s fever and abdominalpain subsided after the treatment.

CLINICAL AND LABORATORY CHARACTERISTICS OF LIVER ABSCESS PATIENTS AT NGUYEN TRI PHUONG HOSPITAL

Background: Liver abscess is a common disease in tropical countries, including Vietnam. Nguyen Tri Phuong Hospital has treated many cases of liver abscesses since 2010. However, there has not been a research report summarizing the clinical and subclinical characteristics of liver abscess cases here. Subjects and methods: Retrospective study of patients diagnosed with a liver abscess at Nguyen Tri Phuong Hospital from January 2017 to December 2022. Results: There were 61 patients diagnosed with a liver abscess at the General Surgery Department of Nguyen Tri Phuong Hospital from January 2017 to December 2022 with the following characteristics: male/female ratio of 1.65/ first; average 56.1 ± 12.3 years old, history of diabetes accounted for 32.8%; The prominent clinical symptoms are fever (88.5%), right upper quadrant pain (85.2%). The average volume of liver abscess on ultrasound was 377.2 ± 50.4 ml, the liver abscess located in the right liver accounted for 73.4%, most of which was a single abscess (78.7%). Klebsiella pneumonia was cultured with the highest rate of 42.6% (26/61) Conclusion: Liver abscess is more common in the elderly, more in men than in women with common symptoms including fever and right upper quadrant pain. Klebsiella pneumoniae became the most common cause of the liver abscess.

The impact of liver abscess formation on prognosis of patients with malignant liver tumors after transarterial chemoembolization.

Liver abscess is a rare and serious complication after transarterial chemoembolization (TACE) for liver cancer; however, its impact on the prognosis is unclear. This retrospective study examined the outcomes of patients with liver abscess formation following TACE for malignant liver tumors to elucidate the impact of liver abscess formation on the prognosis of thesepatients. From January 2017 to January 2022, 1,387 patients with malignant tumors underwent 3,341 sessions of TACE at our hospital. Clinical characteristics of patients at baseline and follow-up were examined, including treatment and outcome of liver abscess, tumor response to the TACE leading to liver abscess, and overall survival time. Of 1,387 patients, 15 (1.1%) patients with liver abscess complications after TACE resulted in a total of 16 (0.5%) cases of liver abscess after 3,341 TACE sessions (including one patient with two events). After antibiotic or percutaneous catheter drainage (PCD) treatment, all the infections associated with liver abscesses were controlled. In the PCD group, eight patients died before drainage tube removal, one retained the drainage tube until the end of follow-up, and five underwent drainage tube removal; the mean drainage tube removal time was 149.17 ± 134.19 days. The efficacy of TACE leading to liver abscess was evaluated as partial response (18.75%), stable disease (37.5%), and progressive disease (43.75%). Eleven patients died during the follow-up period owing to causes unrelated to infections caused by liver abscesses. The survival rates at 3 months, 6 months, 1 year, and 5 years were 86.7%, 50.9%, 25.5%, and 17%,respectively. Patients with liver abscess formation following TACE for malignant liver tumors experienced prolonged drainage tube removal time after PCD; while this condition did not directly cause death, it indirectly contributed to a poor prognosis in these patients.

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.

Liver Abscesses Due to Fusobacterium nucleatum: A Case Series

Abstract Fusobacteriae are anaerobic gram-negative bacilli, classically involved in the development of septic thrombophlebitis of the internal jugular vein in Lemierre syndrome. The goal of this study is to describe the various presentations, treatment course, and outcomes of patients with Fusobacterium liver abscess(es) and review available literature on this topic. We retrospectively reviewed our microbiologic database for positive cultures of Fusobacteriae species in a tertiary care hospital from July 2018 through November 2022 and identified 5 cases of liver abscess that involved Fusobacterium nucleatum species. Patients presented with a syndrome of fever and chills, abdominal pain, and nausea and vomiting. Laboratory investigations revealed leukocytosis and transaminitis, and imaging revealed liver abscess(es). The identification of the F. nucleatum bacteria involved invasive aspiration of the abscess in all but one case, where it was identified on blood cultures. One patient had a florid picture of sepsis and acute respiratory distress syndrome. All patients responded well with intravenous antibiotics and were discharged home to complete a prolonged course until radiographic resolution. In 3 patients, history and imaging were suggestive of possible sources that may have hematogenously spread to the liver, with history of recent appendectomy in 1 patient, possible appendicitis on computed tomography of the abdomen in another patient, and recent dental manipulation in the third patient. In conclusion, Fusobacteriae should be included in the differential diagnosis of liver abscess, especially in the setting of recent appendicitis or dental disease. Effective treatment includes surgical drainage when feasible and prolonged course of antibiotics with goal of radiologic resolution.

Liver Abscess Caused by Klebsiella Pneumoniae, Series of Cases with Different Management

Abstract We present two cases of liver abscess caused by Klebsiella pneumoniae with different management, one of them resolved under antibiotherapy without theraputic drainage. Klebsiella pneumoniae is a gram-negative, lactose-fermenting, rod-shaped bacterium that is part of natural intestinal flora and one of the common causes of nosocomial infections. The liver is one of the viscera in which abscesses frequently occur and is associated with intraabdominal or hepatobiliary diseases. The first patient was admitted to „Prof. Dr. Agrippa Ionescu” Hospital with sepsis due to liver abcess. The CT examination revealed a liver lesion in segments VI-VII, limited by a hypodense margin with fluid-parafluid content (with maximal axial diameters 54/32 mm), without any other focal hepatic lesions. Laboratory workup revealed neutrophilia and lymphopenia, anemia, trombocytopenia, increased inflammatory syndrome, a high level of procalcitonin and blood cultures positives with Klebsiella pneumoniae sensitive. Based on the information presented, the diagnosis established was liver abscess caused by Klebsiella pneumoniae with favorable outcome under initial empirical antibiotherapy with Vancomycin and Meropenem, de-escalated later to I.V. Ceftriaxone, due to the result of the antibiogram. At the 14 day mark, an abdominal CT reveals a slight dimentional progression. Percutaneous ecographic guided drainage was considered but the patient denied it.The patient was released with the antibiotherapy recomandation of 14 more days of orally administered Cefixime. After 4 weeks of antibiotherapy treatment, the patient is ecographically reassesed. The liver abscess is observed to have achieved complete remission without drainage, despite the classical literature recommended protocol. The second case, a male patient admitted with sepsis due to multiple liver abscess (the largest one 100/50 mm with negative blood cultures and unfavorable outcome, despite maximal empirical therapy. Percutaneous ecographic guided drainage was performed and Klebsiella pneumoniae was isolated from the drainage samples .Under target antibiotherapy with Ertapenem for 4 weeks the outcome was very good with complete resolution of the hepatic lesions. Hepatic abscess is associated with a high mortality rate and several complications, despite its low incidence. Prompt recognition is important for effective management and achieving good outcomes. Usually, the liver abscess is treated by either percutaneous drainage or surgical drainage in combination with antibiotics.The key to succesful outcomes is early diagnosis, institution of appropriate therapy and attentive evolution monitoring.More prospective trials with large cohorts are needed to refine our understanding of this serious condition.

S3745 Payback for the Recreation: An Interesting Case of Ketamine-Related Liver Abscesses

S3745 Payback for the Recreation: An Interesting Case of Ketamine-Related Liver Abscesses