Multiple Liver Abscesses Research Articles

Prognostic factors in non-malignant and non-cirrhotic patients with portal cavernoma: An 8-year retrospective single-center study

To evaluate the outcome of non-malignant and non-cirrhotic patients with portal cavernoma and to determine the predictors for survival. Between July 2002 and June 2010, we retrospectively enrolled all consecutive patients admitted to our department with a diagnosis of portal cavernoma without abdominal malignancy or liver cirrhosis. The primary endpoint of this observational study was death and cause of death. Independent predictors of survival were identified using the Cox regression model. A total of 64 patients were enrolled in the study. During a mean follow-up period of 18 ± 2.41 mo, 7 patients died. Causes of death were pulmonary embolism (n = 1), acute leukemia (n = 1), massive esophageal variceal hemorrhage (n = 1), progressive liver failure (n = 2), severe systemic infection secondary to multiple liver abscesses (n = 1) and accident (n = 1). The cumulative 6-, 12- and 36-mo survival rates were 94.9%, 86% and 86%, respectively. Multivariate Cox regression analysis demonstrated that the presence of ascites (HR = 10.729, 95%CI: 1.209-95.183, P = 0.033) and elevated white blood cell count (HR = 1.072, 95%CI: 1.014-1.133, P = 0.015) were independent prognostic factors of non-malignant and non-cirrhotic patients with portal cavernoma. The cumulative 6-, 12- and 36-mo survival rates were significantly different between patients with and without ascites (90%, 61.5% and 61.5% vs 97.3%, 97.3% and 97.3%, respectively, P = 0.0008). The presence of ascites and elevated white blood cell count were significantly associated with poor prognosis in non-malignant and non-cirrhotic patients with portal cavernoma.

Behçet’s disease complicated by multiple aseptic abscesses of the liver and spleen

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease, especially in Crohn's disease, and in other diseases. However, aseptic abscesses associated with Behçet's disease are extremely rare. We report a Japanese male diagnosed with an incomplete type of Behçet's disease who developed multiple aseptic abscesses of the spleen and liver. In 2002, the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum. As the patient's response to antibiotic treatment was inadequate, a splenectomy was performed. Severe inflammatory cell infiltration, largely of polymorphonuclear neutrophils, was observed without evidence of bacterial or fungal growth. Although the patient had no history of ocular symptoms or genital ulcers, a diagnosis of incomplete Behçet's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002. In 2005, multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Behçet's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy. Oral prednisone (15 mg/d) was started in May 2006, and the abscesses dramatically disappeared 4 wk after treatment. Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone, the augmentation of prednisone dosage yielded a response. The abscesses of the liver and spleen were strongly suggested to be attributed to Behçet's disease. Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Behçet's disease.

Multiple pyogenic liver abscesses formed after appendectomy: The role of percutaneous drainage in a critically ill patient

Multiple pyogenic liver abscesses formed after appendectomy and their percutaneous treatment with multiple catheters have been rarely described. We report a case of multiple pyogenic liver abscesses in a critically ill patient, formed after appendectomy and treated successfully by antibiotics and drainage with six catheters that were introduced simultaneously under ultrasound control. Even though this was a case of liver abscess secondary to appendicitis, today very rare in Western countries, but still a serious complication in developing countries, it was successfully resolved by percutaneous drainage, along with antibiotic therapy. We emphasize the advantages of percutaneous treatment compared with surgery regarding the avoidance of perioperative complications and the risks of general anesthesia.

English

Pyogenic liver abscess is a serious disease, which is potentially fatal if left untreated. In developed countries, pyogenic abscesses are the most common but worldwide, amoebae are the most common cause. We report a 60-year-old diabetic woman with a 2 months history of pain abdomen, 1 month history of high fever and anorexia who had multiple liver abscess caused by anaerobic Actinomyces species and Enterococcus faecalis and was complicated by peritonitis. Treatment included prompt percutaneous drainage coupled with long-term intravenous administration of Amikacin, Metronidazole and Piperacillin/ Tazobactum. The patient later died due to peritonitis.

Polymicrobial Multiple Intraabdominal Infections - A Rare Complication of Colonoscopy in a Cirrhotic Patient

Case Description: A 58-year-old male with a history of HCV and alcohol related advanced cirrhosis, presented with altered mental status and right upper quadrant pain, three days following upper and lower endoscopy. The endoscopy showed hemorrhoids and minimal gastritis and no interventions were performed. Diagnostic work-up upon admission showed elevated white blood cell count. CT abdomen showed multiple liver abscesses, which were partially drained and grew Streptococcus anginosus and Staphylococcus epidermidis. There were no other intra-abdominal fluid collections or abscesses, no features suggestive of bowel perforation on imaging. Blood cultures grew E. coli. His condition gradually deteriorated despite treatment with appropriate antibiotics. Repeat CT scan 10 days later showed right upper lobe pneumonia, bilateral pleural effusion along with persistent liver abscesses and new ascites. Paracentesis revealed an exudate with WBC count of 8125 with 94% neutrophils and grew Klebsiella pneumoniae. Antibiotics were adjusted according to sensitivities. However, his condition continued to deteriorate and he finally died of severe sepsis and multi-organ dysfunction. Discussion: There is a wide variation in the rate of bacteremia after various endoscopic procedures ranging from 2 to 45% based on type of procedure performed. They occur predominantly following interventional procedures. To our knowledge, there have only been two cases of bacterial peritonitis following colonoscopy in patients undergoing continuous ambulatory peritoneal dialysis and 2 other instances in patients with cirrhosis and ascites. Septicemia has been reported in only 4 cases after colonoscopy. These include 2 patients with cirrhosis and ulcerative colitis who developed gram negative septicemia; a patient who underwent splenectomy and was taking corticosteroids developed septicemia with Flavobacterium meningosepticum and Escherichia coli; and Listeria in a patient being treated with ACTH for ulcerative colitis. Conclusions: Patients with cirrhosis have a higher rate of infectious complications, likely due to decreased compliment levels, impaired neutrophil chemotaxis, lymphocyte dysfunction and immunoglobulin dysfunction, combined with portal hypertensive colopathy due to venous congestion. In summary, infectious complications following diagnostic endoscopies in cirrhotics are rare but can be severe and life threatening, even without obvious signs of bowel perforation.

A unique variant of intestinal tuberculosis.

Duodenum is a rare site of involvement in intestinal tuberculosis. We report a 19 years old boy who presented with nonbilious vomiting and weight loss. His workup showed stricture in ascending colon, multiple liver abscesses with pneumobilia on CT scan. Upper GI endoscopy revealed stricture in 2nd part of duodenum distally. He was operated and duodenojejunostomy with limited right hemicolectomy (for stricture in this part of gut) were done. Biopsy report was suggestive of tuberculosis. Antituberculous treatment was started. He responded well and gained 20 kg weight at 3 months follow-up.

Hepatobiliary and Pancreatic: Hepatic actinomycosis

A 72-year-old man was investigated because of a 1-week history of fever, headache and myalgia. Seven years previously, he had been diagnosed with gastric adenocarcinoma and treated with a subtotal gastrectomy. On admission to hospital, his temperature was elevated (38.3°C) but no other abnormalities were detected on physical examination. Laboratory tests revealed mild anemia (hemoglobin 114 g/l), an elevated white cell count (12.6x10/l) and a mild elevation of C-reactive protein (13.6 mg/l), aspartate aminotransferase (53 u/l), alanine aminotransferase (65 u/l), alkaline phosphatase (222 u/l) and g-glutamyl transferase (264 u/l). His serum glucose was also elevated. A contrast-enhanced computed tomography (CT) scan showed several lesions of low-attenuation in both lobes of the liver (Figure 1). The differential diagnosis included liver abscesses and liver metastases. A percutaneous aspirate was obtained under ultrasound guidance and yielded thick brown turbid fluid. In wet-fixed smears, blue colonies of actinomycosis with “bales of wool” appearance were seen on a background of mixed inflammatory cells (Figure 2). In cell-block sections, there were many irregularly lobulated or scalloped basophilic granules termed “sulphur granules” that are characteristic of Actinomyces. There was no evidence of metastatic adenocarcinoma. Gram staining revealed positive filamentous bacilli (Figure 2 inset, white arrow). The patient was treated with percutaneous drainage for 2 weeks and with high-dose penicillin-G given intravenously. His fever subsided after 2 weeks and laboratory tests gradually returned to normal. The abscesses had resolved on repeat CT scan after 2 months. Hepatic actinomycosis is a rare disease. Although cases of primary hepatic actinomycosis have been described, actinomycosis appears to spread to the liver from other abdominal sites in the majority of cases. Symptoms are often non-specific with weight loss and fever. However, most patients with hepatic actinomycosis have an elevated serum alkaline phosphatase level in addition to a leucocytosis and elevated erythrocyte sedimentation rate. The typical radiological feature is that of multiple liver abscesses but multiple small lesions may be difficult to characterize. Percutaneous aspirates can be diagnostic when they contain “sulphur granules” with gram-positive bacilli. Cultures are positive in some but not all patients. Larger abscesses can be treated by percutaneous drainage but eradication of the infection usually requires prolonged courses of intravenous penicillin. The evolution of hepatic abscesses caused by actinomycosis is usually more insidious than that associated with pyogenic abscesses.

Multiple liver abscesses in a child

Entameba histolytica is a protozoan that usually causes procto-colitis. E. histolytica amebiasis is endemic in tropical countries but exceedingly rare in the US Amebic liver abscess commonly presents with fever, abdominal distension, right upper quadrant pain/tenderness, hepatomegaly, and tachycardia. We discuss the presentation/diagnosis of amebiasis in a child who had visited Mexico and the difficulty of early diagnosis when there is no evidence of intestinal infection. Ultrasonography and/or CT were essential diagnostic tools and an IgG antibody study confirmed the diagnosis. Management included oral metronida-zole and abscess drainage.

Disseminated Infection Caused byEggerthella lentain a Previously Healthy Young Man: A Case Report

Anaerobic bacteria are the predominant normal flora of the mucous membranes which may cause life-threatening disseminated infections and are often difficult to culture from infected sites. Eggerthella (previously known as Eubacteria species) is an anaerobic, nonsporulating, nonmotile, Gram-positive rod that is found in the human colon and feces and has been isolated from various other clinical specimens. We report a case of complicated disseminated anaerobic bacterial infection with Eggerthella lenta in a healthy immunocompetent man causing multiple brain abscesses, liver abscesses, necrotizing pneumonia, and osteomyelitis of the left radial bone. He was successfully treated with empiric penicillin G and metronidazole.

多発肝膿瘍をきたした進行胃癌の1例

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

Amoebic Liver Abscess: An Appraisal

Amoebic Liver Abscess: An Appraisal

Fatal septicaemia caused by <i>Chromobacterium violaceum</i>

We report a case of Chromobacterium violaceum septicaemia in a 10-year old boy admitted to hospital in September 2001, two weeks after he suffered a crush injury of the left foot. In spite of surgical debridement and antibiotics his condition worsened and he developed multiple liver and lung abscesses. He died one week after admission and a blood culture grew Chromobacterium violaceum.

Inflammatory pseudotumor of the liver and spleen.

We report the case of a 44-year-old woman with an inflammatory pseudotumour of the liver and spleen. This concomitant association has been rarely described. Our patient presented with a 2-day history of low grade fever and pain in the right hypochondrium and lower abdomen, and an abdominal scan revealed a contrast-enhanced mass in the liver in addition to an enlarged spleen with another contrast-enhanced mass. The patient was admitted to the hospital with the diagnosis of multiple liver abscesses and a spleen mass which suggested a neoplasm such as lymphoma. The final diagnosis was made by ultrasound-guided liver mass biopsy, and splenectomy. We review the literature, and highlight the difficulties of diagnosing this entity.

A case of liver nocardiosis associated with Crohn's disease while treating infliximab

A 23-year-old man, complaining of chronic diarrhea, was given a diagnosis of Crohn's disease. He responded well to steroid therapy and infliximab administration. However, high fever appeared on the 28th day of hospitalization, and CT scan revealed multiple liver abscesses. Gram-positive branched rods were harvested by ultrasonography guided puncture examination. As Nocardia infection was suspected, sulfamethoxazole-trimethoprim was started immediately, and his clinical course improved dramatically. Afterwards, Nocardia farcinica was isolated from the culture of the liver abscess. This case is the first report of liver nocardiosis associated with Crohn's disease. Generally, Nocardia infection can be successfully treated by sulfamethoxazole-trimethoprim therapy. Liver nocardiosis is very rare but could be an important complication for patients with Crohn's disease.

Tuberculous hepatic abscess appearing after liver transplantation in a patient with human immunodeficiency virus and hepatitis B and C virus co-infection

Tuberculosis infection occurs relatively frequently in solid organ transplant recipients, although the occurrence of tuberculous hepatic abscesses is uncommon. Anti-tuberculous therapy has several concerns in transplant recipients, including an increased risk of cellular rejection and potential hepatotoxicity. We present the case of a human immunodeficiency virus-infected liver transplant patient who developed multiple tuberculous liver abscesses. Treatment with isoniazid, ethambutol, pyrazinamide, and moxifloxacin was efficacious, well tolerated, and safe.

Bilateral Klebsiella pneumoniae (K1 Serotype) Endogenous Endophthalmitis as the Presenting Sign of Disseminated Infection

The authors report a rare presentation of bilateral Klebsiella pneumoniae endophthalmitis in an ambulatory patient without other known medical conditions. A 51-year-old Chinese woman presented with severe bilateral reduction in vision, photophobia, pain, and eyelid swelling. Hospital admission and evaluation revealed vitreous, blood, and urine cultures positive for K. pneumoniae (K1 serotype). Additional work-up revealed endocarditis, multiple liver abscesses, brain abscesses, and left lobar pneumonia. The patient underwent multiple bilateral intravitreal antibiotic injections. Ultimate visual acuity was no light perception in both eyes. K. pneumoniae endogenous endophthalmitis is a severe but potentially subclinical disease. Early diagnosis requires a high index of suspicion and recognition of risk factors including Asian ancestry and other sources of systemic infection including, most commonly, liver abscess.

Liver abscess caused by periodontal bacterial infection with Fusobacterium necrophorum

Liver abscess is recognized as a life-threatening disease. However, even in recent years, approximately 50% of liver abscess cases are considered to be cryptogenic. Here, we report a case of liver abscess associated with periodontal bacterial infection by Fusobacterium necrophorum, which is commonly found in the oropharyngeal flora. A 36-year-old man presented with fever and contrast-enhanced abdominal computed tomography revealed multiple liver abscesses. F.necrophorum was isolated from oral smears, liver aspirates and blood samples. Liver abscesses caused by periodontal bacterial infection are rare, however, the incidence is expected to increase in the future, as periodontitis is extremely common and is on the rise as one of the most common chronic infections in the world. A systemic survey including periodontitis may be required for the exact diagnosis of the source of infection.

Identification ofLegionella feeleiiCellulitis

Identification of<i>Legionella feeleii</i>Cellulitis

A case of phlegmonous gastritis with multiple liver and splenic abscesses

A case of phlegmonous gastritis with multiple liver and splenic abscesses

InvasiveKlebsiella pneumoniaeInfections, California, USA

Invasive<i>Klebsiella pneumoniae</i>Infections, California, USA