Multiple Liver Abscesses Research Articles

Multiple Liver and Jejunal Abscesses Due to Fasciola Flat Worm: An Uncommon Case Report from Iran.

Fascioliasis is a zoonotic condition precipitated by the trematode known as Fasciola spp. This parasite affected almost 2.4 to 17million individuals in the world. The occurrence of liver abscesses is an infrequent phenomenon, potentially arising as a secondary outcome of cholangitis or hepatic inflammation. In this study, we have reported a case of a hepatic abscess induced by Fasciola spp. A 29-year-old male presented with generalized abdominal discomfort, primarily concentrated in the right upper quadrant, which had progressively worsened over the past seven months. The patient did mention a weight loss of approximately 10kg during the course of their illness, along with increasing fatigue. Eosinophilia was seen too (35%). The stool exam test was negative. An enteroscopy was conducted, revealing no pathological abnormalities. Following this, the surgeon prescribed a surgical biopsy of the mass, which yielded a diagnosis of multiple eosinophilic granulomatous abscesses within the jejunal wall and mesentery. The Fasciola IgG test returned a positive result. After of follow-up, the patient fully recovered. Fascioliasis should be considered in the differential diagnoses of liver abscesses. Because of earlier diagnosis, can be avoided of invasive diagnostic tests and therapeutic interventions can be started earlier.

A case of amebiasis with multiple liver abscesses: A way to diagnosis

Amebiasis is a protozoal disease common for tropical countries. It is not frequently diagnosed in Central Russia, and is mainly seen in travelers, people with immunodeficiency, as well as in men who have sex with men. The main manifestation of the disease is intestinal damage with the development of diarrhea. With the hematogenic spread of the pathogen, extra-intestinal lesions of different organs may develop with the formation of abscesses in them. The liver, lungs, brain, and skin are most often involved in the inflammatory process. In this article, we describe a case of extrahepatic amebiasis with multiple liver abscesses, which presented difficulties in diagnosis. We provide details of observation and key laboratory findings as well as results of radiological examinations. Appearance of imported amebiasis in the Moscow region proves its actual importance and significance of timely diagnosis and etiotropic therapy. The aim of the article is to draw attention to the problem of diagnosis and prophylaxis of amebiasis in Central Russia as a result of migration and tourism to endemic territories.

Young Man With Multiple Partially Septated Cysts in the Hepatoduodenal Ligament and Retropancreatic

The differential diagnosis of cystic liver changes includes multiple dysontogenetic cysts, liver abscesses and amoebic abscesses. Cystic changes in the abdomen with partly necrotic lymph nodes should also suggest tuberculosis, even in young and immunocompetent patients. In tuberculosis hepatoduodenal lymphadenopathies can be observed, and necrotic lymph nodes might mimic other thin-wall cystic lesions. Unexplained weight loss with clinical signs of severe infection and septicaemia also includes a differential diagnosis of consumption, i.e. miliary tuberculosis and treated immediately.

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.

A Rare Case of Charcot-Leyden Crystals In liver biopsy in a 14-Year-Old Boy with Persistent Fever and Miliary Infiltrates

The presence of Charcot-Leyden Crystals in liver biopsy is rare. A report case of a 14-year-old boy who presented with persistent fever and respiratory symptoms. Chest X-ray and CT thorax showed miliary infiltrates. The Mantoux test was positive and sputum for acid-fast bacilli (AFB) was negative. The patient started antitubercular therapy (ATT). There was no response and the patient still had fever. Further evaluation with an ultrasound of the abdomen revealed multiple small liver abscesses with septic emboli in the spleen. Since the patient was non-responsive to antibiotics, biopsy from the lesion in the liver was suggested. Biopsy report revealed Charcot-Leyden crystals with no granulomas. The Patient was diagnosed as a case of systemic parasitic infestation. Albendazole under steroid cover was prescribed and the patient was afebrile on follow-up. It was concluded that the presence of CLCs in a biopsy specimen is rare but may be a cause of an underlying parasitic infestation. Early diagnosis and treatment with antiparasitic drugs can lead to a favorable outcome.

Melioidosis presenting with multiple liver abscesses

Abstract A 48-year-old male patient presented with a history of fever, abdominal pain and cough for the preceding 14 days. Abdominal examination revealed tenderness in the right hypochondrium. Radiological features were suggestive of multiple liver abscesses. Ultrasonography-guided percutaneous catheter insertion into the largest measuring abscess was done. Pus culture grew Burkholderia pseudomallei spp. The patient was started on intravenous meropenem initially which was changed to IV cefoperazone-sulbactam as per the sensitivity pattern. The patient died on the 16th day of admission due to refractory septic shock. The present case highlights the fact that melioidosis is emerging as an important cause and should be considered in the differential diagnosis in patients presenting with multiple liver abscesses and systemic sepsis.

Chronic granulomatous disease identified in the evaluation of atypical Kawasaki disease in an infant

An 8-week-old full-term male was admitted after 5 days of fever and cough. He was previously admitted at 3 weeks of age for a Klebsiella pneumoniae urinary tract infection (UTI) and treated with 10 days of antibiotics. Blood and cerebrospinal fluid cultures, serum inflammatory markers, and respiratory viral testing obtained at that time were negative. During the current admission, urine cultures grew Klebsiella oxytoca and he was again treated for a UTI.His fevers persisted and on day 8 of illness he met criteria for atypical Kawasaki disease with elevated inflammatory markers, elevated liver enzymes, thrombocytosis, leukocytosis, and anemia. Prior to initiating IVIG, the patient underwent abdominal ultrasound to rule out occult infection, revealing multiple liver and spleen abscesses. Aspirated fluid grew Serratia marcescens and he was started on cefepime. Additional imaging of the chest, abdomen, and pelvis revealed pulmonary nodules. Evaluation of these nodules demonstrated no additional mycobacterial, fungal, or bacterial infections.Chronic granulomatous disease (CGD) was suspected based on the patient’s age, multi-organ abscesses with Serratia marcescens, and parental consanguinity (first cousins). Neutrophil oxidative burst testing showed absent ROS production. Genetic testing demonstrated a homozygous pathogenic variant in NCF2 (exon 3 deletion), confirming the diagnosis of autosomal-recessive CGD. He received high-dose methylprednisolone with a prolonged taper to promote antibiotic penetration of his CGD-associated liver abscesses. Repeat imaging showed interval improvement and the patient began prophylactic itraconazole and trimethoprim-sulfamethoxazole.Familial testing revealed heterozygous carrier status of the same NCF2 variant in both parents and the patient’s two sisters. At 10 months of age, the patient underwent a 10/10 matched sibling bone marrow transplant. Chimerism studies showed rapid neutrophil engraftment with delayed T cell engraftment. As of follow up at 12 months of age, he has appropriate post-transplant weight gain, no infectious complications, and no evidence of GVHD.Initial presentation in patients with CGD and liver/spleen abscesses can be insidious with isolated fever and elevated inflammatory markers. Such patients can readily meet criteria for atypical Kawasaki disease, highlighting the importance of maintaining a broad differential diagnosis for fever of unknown origin with a high index of suspicion for primary immunodeficiency.

What’s the Cure for These Hiccups?: A Case of Area Postrema Syndrome due to Ventriculitis (P8-10.006)

<h3>Objective:</h3> N/a <h3>Background:</h3> 59-year-old man with history of diabetes and hypertension who presented for confusion, generalized weakness, and intractable nausea and vomiting. <h3>Design/Methods:</h3> N/a <h3>Results:</h3> Initial evaluation revealed diabetic ketoacidosis with blood pH of 7.16 and serum glucose &gt;500. CT Head W/O contrast was unremarkable. CT Chest/Abd/Pelvis showed multiple liver abscesses and bilateral pulmonary emboli. Patient was admitted to surgical ICU for acute management and hepatic drains. His urine, liver and blood cultures grew Klebsiella pneumoniae. On hospital day 5, MR brain W/+ W/O was obtained for worsening encephalopathy. This showed multifocal punctate infarcts and diffusion-restricting-fluid layering within the lateral ventricles and fourth ventricle. Transthoracic echocardiogram revealed a hypermobile mass attached to the aortic valve. General exam was notable for intractable hiccups; mental status and neurologic exam was unremarkable. <h3>Conclusions:</h3> Bacterial ventriculitis is a severe complication of CNS infections with a mortality rate of 42%. Common presenting symptoms are fever, headache, photophobia, phonophobia and nausea. To this date, area postrema syndrome (APS) has not been documented as one of its sequelae. APS is usually associated with NMO-SD and characterized by intractable nausea, vomiting, and hiccups secondary to anti-AQP4 mediated damage to the circumventricular organ of the 4^th ventricle, the <i>area postrema.</i> The area postrema is located within the dorsal medulla and made up of fenestrated capillaries and sensory neurons that together form the chemoreceptor trigger zone responsible for, amongst other functions, detecting toxins in the blood to induce emesis. It may be susceptible to any chemical stimuli within the ventricular system, including the purulent exudates of an active infection. The diffusion restriction within the caudal 4^th ventricle and dorsal medulla of this patient’s MRI suggests a plausible substrate for area postrema syndrome and establishes bacterial ventriculitis as one of its possible etiologies. <b>Disclosure:</b> Dr. Wadood has nothing to disclose. Dr. Etter has nothing to disclose. Dr. Falero Pomales has nothing to disclose.

Percutaneous drainage of liver abscess under ultrasound guidance combined with etiological antibacterial therapy: a successful case of patient treatment

The article describes a clinical case of successful treatment of multiple liver abscesses in a 43‑year-old man with severe comorbidity and history of aggravating factors. The patient underwent combined treatment: surgery, consisting in the abscess puncture, and antibacterial therapy, first empirical, then etiological, taking into account the data of bacteria culture test. The importance of rational combinations of surgical care and antibacterial therapy is also discussed.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.

Pyogenic liver abscess following endoscopic retrograde cholangiopancreatography procedure for choledocholithiasis

Pyogenic liver abscess (PLA) is a condition in which there is pus accumulation in the liver. It usually develops in the context of portal pyemia, through hematogenous seeding as well as via biliary disease. PLA is a rare, but important complication following biliary instrumentation such as endoscopic retrograde cholangiopancreatography (ERCP). We report a case of a 44-year-old man who initially presented with clinical features of ascending cholangitis. Laboratory investigations revealed leukocytosis as well as hyperbilirubinemia. Diagnosis of choledocholithiasis was then confirmed with an ultrasound examination, showing a 1×1 cm stone in the common bile duct. ERCP was performed and achieved stone clearance. However, the patient returned 1 month later with similar symptoms of right upper quadrant pain, fever and jaundice. Suspecting recurrent choledocholithiasis, an emergency ERCP was performed and showed pooling of radio-opaque contrast in the extra-biliary space. There were also multiple CBD stones seen. An urgent CT Abdomen was done and revealed multiple liver abscesses in bilateral liver lobes, with the largest measuring 4.5x5.9x2.1cm. The patient was treated conservatively with Augmentin and repeat ultrasound at 4 weeks interval showed no residual liver abscess.

Visceral Larva Migrans Presenting as Multiple Liver Abscesses

Visceral Larva Migrans Presenting as Multiple Liver Abscesses

Mediastinal extension of amoebic liver abscess: A case report on the rare thoracic complication of Entamoeba histolytica

Amoebic liver abscess is one frequently encountered intra-abdominal infection, caused by Entamoeba histolytica and has various abdominal and thoracic life-threatening complications. Herein, describe a case of a 30-year-old female, who suffered from multiple amoebic liver abscesses and presented with massive right-sided pleural effusion. She was managed with recommended antibiotics and pigtail catheter for liver abscess and an intercostal drainage tube for massive pleural effusion. However, postintercostal drainage, her chest X-ray demonstrated a right mediastinal shadow, which was confirmed as an intrathoracic extension of the hepatic liver abscess on computed tomography. An ultrasound-guided pigtail catheter was manipulated and placed at the site of thoracic communication. This led to clinical and radiological improvement, but unfortunately, she developed ventilator-acquired pneumonia and died due to her illness. The case represents an uncommon complication of amoebic liver abscess, which is rarely described and adds more knowledge on the thoracic complexities of this infectious disease.

S2888 A Case of a Completely Migrated Gastric Toothpick Caught by EUS

Introduction: Foreign body ingestion is a common cause for medical emergencies. Once they reach the stomach, roughly 80% of foreign bodies pass uneventfully through the GI tract. Sharp objects, such as toothpicks, are more likely to cause injury throughout the GI tract. Toothpick ingestion is associated with high rates of mortality and morbidity, with estimated 79% of ingestions leading to gut perforation. Initial diagnosis can be difficult, as ingestion has been found to mimic other conditions, such as renal colic. Endoscopy is warranted in roughly 20% of cases, with about 1% requiring surgical intervention. Case Description/Methods: A 63-year-old male with a history of HTN and DM presented with a 1-week history of altered mental status, fevers, nausea, vomiting, and melena. CT revealed a linear density extending from the lumen of the distal gastric antrum to the posterior wall of the stomach traversing the pancreas in the expected location of the SMV. Follow up EGD and MRI failed to reveal foreign body. He subsequently developed actinomyces bacteremia, was treated with antibiotics along with dental extraction, and was discharged home. The patient later returned with septic shock, found to have recurrent Actinomyces bacteremia. CT re-demonstrated suspicious thin linear density as well as multiple liver abscesses. Again, EGD failed to reveal foreign body. This time, an EUS was performed, and the foreign body was localized to the antrum, 2.4 mm below the luminal surface. Endoscopic mucosal resection was attempted but was unsuccessful. The patient then underwent an exploratory laparotomy with the retrieval of a wooden toothpick. He discharged in stable condition. Discussion: In this case, original CT scans revealed a possible foreign body, the object being localized as expected near the SMV. Given original negative EGD and MRI, it was felt that CT scan findings represented vasculature. When patient returned in septic shock with recurrent actinomyces bacteremia, a second EGD was performed and was negative. A decision was made at that time to investigate with EUS as a diagnostic tool, which ultimately revealed the location of the foreign body. What makes our case particularly unique is the degree of foreign body migration into the gastric wall, causing difficulty in diagnosis through EGD. This case highlights EUS as an important diagnostic modality in cases of foreign body ingestion.

A wide clinical spectrum of pulmonary affection in subjects with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA)

BackgroundKlebsiella pneumoniae is a major pathogen of bacterial liver abscess in Asia. Particularly, patients with community-acquired Klebsiella pneumoniae liver abscess (CA-KPLA) tend to have a higher risk of invasive infection and pulmonary is a common invasive infectious site, making it a global clinical crisis. Therefore, considerable attention should be focused on the early prediction and active treatment strategies of such patients. MethodsThe clinical data of 127 CA-KPLA cases hospitalized from January 2017 to February 2022 were collected from a single center. Risk factors were analyzed by the use of univariable and multivariable analysis. Furthermore, independent risk factors of pulmonary affection were utilized to construct a predictive nomogram. ResultsThe incidence of pulmonary affection in KPLA patients was 57.5% (73/127) and the majority manifested as nodular lesions with cavities and pleural effusion in chest CT images. Based on the predictive nomogram, the SOFA score (>2) was defined as the most dominant independent risk factor for the occurrence of pulmonary affection, followed by the maximum diameter of liver abscess (>3 cm), multiple liver abscesses, bacteremia, and badly-controlled diabetes sequentially. The validation of this nomogram also demonstrated good discriminative ability and satisfactory consistency. Finally, early drainage of liver abscess, initial combinational antibiotics, and early Carbapenem-including antibiotic usage were established as favorable factors for therapy in pulmonary affected CA-KPLA patients. ConclusionThis study provided an effective model for the early prediction of pulmonary affection in patients with CA-KPLA and some rational strategies for their early therapeutic remission.

Cerebral venous sinus thrombosis in a patient with Klebsiella pneumoniae primary liver abscess: a case report

BackgroundLiver abscess is a common emergency in the emergency department. However, cerebral venous sinus thrombosis (CVST) is a rare and serious cerebrovascular disease. Cases of CVST in patients with Klebsiella pneumoniae primary liver abscess (KLA) have not been described in the literature. We report a case of CVST in patients with KLA.Case presentationA 54-year-old male patient came to our department with a fever for 2 days and altered mental status for 1 day. Abdominal computed tomography (CT) and liver magnetic resonance imaging (MRI) revealed multiple liver abscesses. The blood culture was identified as Klebsiella pneumoniae sepsis. Head contrast-enhanced MRI and magnetic resonance venography (MRV) imaging showed multiple thrombus formation in the right transverse sinus and sigmoid sinus. The patient's infection and thrombosis were controlled within one week of multidisciplinary comprehensive treatment such as antibiotic and antithrombotic therapy, and a good clinical recovery during the 1-month follow-up.ConclusionCVST after liver abscess is rare, clinicians should be aware of this complication and vigilant for the possibility of bacterial meningitis. The underlying mechanisms need to be further studied.

Toddler With Fever and Limp.

Toddler With Fever and Limp.

The experience of use of percutaneous transhepatic biliary drainages for early biliary complications after liver transplantation.

This study aimed to describe our experience and discuss the results, controversies, and the use of percutaneous transhepatic biliary drainage (PTBD) in patients with biliary complications after liver transplantation (LT). Between November 2009 and August 2020, 76 consecutive patients who underwent 77 LTs (44 deceased donor LTs and 33 living donor LTs [LDLT]) were enrolled retrospectively. Endoscopic therapy as initial approach and PTBD as rescue therapy were used for patients with biliary complications. There were 31 patients (31/76, 40.8%) with biliary complications, and two of them died (2/31, 6.5%). Clinical success rate of endoscopic therapy alone was 71.0% (22/31). The remaining nine patients received salvage PTBD and their clinical results were observed according to whether their intrahepatic bile ducts (IHBDs) was dilated (group A, n=5) or not (group B, n=4). In group A, the technical and long-term clinical success rates of PTBD were 100% and 20%, respectively. These five patients received PTBD ranging from 75 to 732 days after their LTs, and no procedure-related complications were encountered. In group B, the technical and long-term clinical success rates of PTBD were 50% and 25%, respectively. Three group B patients (75%) underwent PTBD within 30 days after LDLT and had lethal complications. One patient had graft laceration and survived after receiving timely re-transplantation. The other two patients died of sepsis due to PTBD-related bilioportal fistula or multiple liver abscesses. Our experience showed salvage PTBD played a limited role in biliary complications without dilated IHBDs within 1 month after LT.

Pyogenic liver abscess due to multidrug-resistant Klebsiella pneumoniae

Pyogenic liver abscess (PLA) is a space-occupying lesion in the liver associated with high morbidity and mortality. There are many risk factors associated with PLA such as underlying hepatobiliary disease, gastrointestinal malignancy, diabetes mellitus and alcoholism. Most PLA cases are polymicrobial caused by mixed enteric facultative and obligate anaerobic bacteria. Here, we present a case of multiple liver abscess caused by Klebsiella pneumoniae in a 46-year-old elderly patient who presented with gastrointestinal symptoms.

A Surgical Case of Gastrointestinal Stromal Tumor of the Stomach with Multiple Liver Abscesses

A Surgical Case of Gastrointestinal Stromal Tumor of the Stomach with Multiple Liver Abscesses