Recurrent Abscesses Research Articles

180 Anti-IL12 autoantibodies in a teenage girl with multiple recurrent abscesses

180 Anti-IL12 autoantibodies in a teenage girl with multiple recurrent abscesses

Splenic abscess presenting as pneumonia with pleural effusion initially: A rare case in a 2-year-old girl: A case report

Rationale: Splenic abscess is rarely discovered during the toddler period. Although most of the cases are typically marked by fever, abdominal pain, and vomiting, some of them may suffer life-threatening situations. This study aimed to explore how early detection can prevent serious disease complications. Patient concerns: A 2-year-old child with persisted fever and shortness of breathing was admitted. Physical examination was decreasing breathing sound on the left side. We gave empirical antibiotics use with chest tube drainage for 2 days in vain. No fever dropping and persistent left upper abdominal pain were noted. A huge mass was found on left spleen incidentally during abdominal ultrasound screen. Diagnosis: Huge splenic abscess. Intervention: High-resolution ultrasound and abdominal computer tomogram were conducted to confirm the diagnosis. Percutaneous drainage under computer tomography-guided with antibiotic use was smoothly. No obvious adverse effects were noted during the treatment course. Rapid clinical improvement with decreasing size was observed by ultrasound 10 days after the treatment and fever subsided. Outcomes: A period of 3-month follow-up revealed no evidence of recurrence of abscess. Lessons: Early diagnosis and intervention are mandatory for splenic abscess to prevent possible ominous consequences. The case study has shown that computer tomography-guided percutaneous drainage, along with appropriate antibiotic therapy, can significantly impact solitary unilocular splenic abscesses, even if they are large. This approach demonstrates the potential to effectively manage splenic abscesses and avoid the need for more invasive procedures such as splenectomy.

Long-term outcomes of intestinal penetrating Crohn's disease following successful nonoperative management.

There is a paucity of data on the surgical or medical treatment for abscess/fistula complicating Crohn's disease after successful nonsurgical management. We conducted a cohort study to investigate the long-term outcomes and the risk factors for the requirement of subsequent surgical intervention in Crohn's disease patients with complicating fistulas/abscess following successful nonsurgical management. Data were collected on penetrating Crohn's disease experiencing successful nonsurgical treatment between December 2012 and December 2021. Long-term outcomes and risk factors of surgery were assessed by univariate and multivariate analysis, and subgroup analysis was performed based on penetrating phenotype including abscess, fistula, and phlegmon. A total of 523 penetrating Crohn's disease patients; there were 390, 125, and 60 patients complicated with fistulas, abscess, and phlegmon, respectively. Long-term outcomes showed that BMI < 18.5 (kg/m 2 ), the recurrent abscess, and stricture were independent risk factors of surgery. Biologics and resolution of abscess were independent protective factors of surgery. Furthermore, in 399 patients undergoing early surgery, stricture and BMI < 18.5 (kg/m 2 ) were independent risk factors, and biologics and abscess resolution were protective of the early surgery. Subgroup analysis based on fistula, abscess, and phlegmon phenotype also demonstrated that concomitant stricture was an independent risk factor and the use of biologics was protective of surgical resection. Our data indicate that biologics can delay the requirement of surgery and may be given to patients with penetrating complicating Crohn's disease who have been successfully treated nonoperatively, but surgical resection should be considered in the setting of malnutrition and stenosis formation.

COMPARISON OF OUTCOME (IN TERMS OF RECURRENCE) OF INCISION &amp; DRAINAGE VERSUS ASPIRATION OF BREAST ABSCESS

Breast abscesses can lead to significant morbidity and have a negative impact on quality of life. This study aimed to compare recurrence rates after incision and drainage versus aspiration techniques in managing breast abscesses. Objective: To compare the outcome of incision and drainage versus aspiration techniques in managing breast abscesses, specifically recurrence rates. Methods: This study employed a Randomized Controlled Trial design and was conducted at the Department of General Surgery, Nishtar Hospital, Multan, over a period of six months from July 1, 2019, to January 1, 2020. A total of 60 patients meeting the inclusion criteria were randomized into two groups: Group A underwent needle aspiration, while Group B underwent incision and drainage. Both groups received a 10-day course of tab. Ciprofloxacin 500mg BD and tab danzen DS BD. The researcher performed all the procedures. Patients were followed for two weeks, and recurrence of the abscess was recorded as either "yes" or "no". Results: The study included 60 patients with a mean age of 25.58 ± 3.64 years. Of these, 35 (58.3%) were from rural areas and 25 (41.7%) from urban areas. Seventeen (28.3%) patients were unmarried, and 43 (71.7%) were married. The mean body mass index was 25.12 ± 1.97 kg/m2, with obesity present in 7 (11.7%) patients. Thirty-five (58.3%) patients were lactating, with a mean abscess duration of 3.25 ± 0.57 months. The mean abscess size was 1.20 ± 0.18 centimeters, with 55 (91.7%) abscesses ≤ 2 centimeters in size. Diabetes was not present in any patients. Recurrence occurred in 15 (25.0%) patients, with a recurrence rate of 13.3% in Group A and 36.7% in Group B (p = 0.072). Conclusion: The recurrence of breast abscesses was lower in the aspiration group compared to the incision and drainage group. These findings support the use of needle aspiration techniques for the management of breast abscesses. Surgeons treating such patients should consider employing aspiration techniques to achieve better outcomes, thereby reducing the burden of related morbidities and mortalities.

A systematic review and meta-analysis of the use of packing in the management of perianal abscesses.

Perianal abscesses are common presentations and reasons for emergency general surgery admissions. Management involves incision and drainage of the abscess and packing the cavity with internal wound dressings. This meta-analysis aimed to assess in adults if packing an abscess or leaving it unpacked leads to a significant difference in the outcomes of pain on wound dressing, time to healing, rate of fistulation and abscess recurrence. Randomised controlled trials (RCTs) with participants aged 18 years or older that compared packing of perianal abscess cavities with no packing between 2002 and 2022 were searched for in December 2022 on OVID Medline and Embase, the CENTRAL register of trials, PubMed and Google Scholar. Risk of bias was assessed using the Cochrane Risk of Bias tool. Random effects meta-analysis was conducted on the data extracted. Three RCTs involving 490 patients were analysed for the outcomes of abscess recurrence and postoperative fistula formation; the data were not adequate to assess pain on dressing and time to healing. For unpacked versus packed, the pooled relative risk of abscess recurrence was 1.57 (95% confidence interval (CI) 0.764, 3.29, p=0.219) and for fistula formation 0.686 (95% CI 0.430, 1.09, p=0.114). These results suggest there is no significant benefit to packing abscess cavities. Analysis of the outcomes suggests there is no significant difference with regards to rates of abscess recurrence or fistula formation between the packed and unpacked groups; however, appropriately powered RCTs are required in this area to provide more primary evidence to inform best practice and clinical management.

Cushing's disease presenting with recurrent abscesses followed by post-remission hyperthyroidism.

We report a case of a 59-year-old woman with Cushing's disease who developed hyperthyroidism following treatment of hypercortisolaemia. The patient with a history of recurrent hospitalisations caused by multi-sited soft tissue abscesses was admitted with sepsis. Both her medical history and physical examination suggested Cushing's syndrome. The initial hormonal diagnostic process, conducted after sepsis treatment, brought forth conflicting results. However, hormonal assessment repeated 3 months later indicated pituitary hypercortisolaemia, which was confirmed through bilateral inferior petrosal sinus sampling and was successfully treated with transsphenoidal pituitary surgery. Three months after the surgery, the patient was readmitted to our epartment with symptoms of hyperthyroidism, which was confirmed by laboratory tests. Thyroid scintiscans indicated Graves' disease. However, the absence of anti-thyroid stimulating hormone antibodies suggested other etiologies of hyperthyroidism. Eventually, the patient underwent radioiodine therapy. Currently, her condition is improving and she has had no recurrence of abscesses, severe infections, or hyperthyroidism. In conclusion, while clinical manifestation of hypercortisolaemia might be non-specific, its treatment may trigger the development of autoimmune diseases. The presence of recurrent severe infections should prompt physicians to consider the possibility of hypercortisolaemia. Chronic hypercortisolism is debilitating and can lead to significant disability. Dexamethasone suppression testing in patients with active or recent severe inflammatory or infectious illnesses may produce misleading or confusing results. Clinicians should be aware of the potential development of autoimmune diseases following successful treatment of hypercortisolaemia.

Actinomycosis turicensis secondary to oral trauma as a cause of recurrent breast abscess

Actinomycosis turicensis secondary to oral trauma as a cause of recurrent breast abscess

462 A Kidney Transplant Recipient’s Dilemma of Recurrent Abscesses, Megalocytic Interstitial Nephritis and Rejections

462 A Kidney Transplant Recipient’s Dilemma of Recurrent Abscesses, Megalocytic Interstitial Nephritis and Rejections

Lupic Glomerulonephritis in a Patient Presenting with Hyperimmunoglobulin E Syndrome: A Case Report

Hyper-IgE syndrome (also known as Job or Buckley syndrome) is a hereditary immune deficiency of autosomal dominant inheritance. It is clinically characterized by the occurrence of recurrent staphylococcal, skin abscesses, bacterial and fungal pneumopathies, and a significant increase in immunoglobulin E. Its association with systemic lupus erythematosus has been described, the mechanism of which involves the deposition of immune complexes. We report the case of an 11-year-old girl with hyper IgE syndrome who was admitted to our clinic with severe renal failure, diagnosed as lupus glomerulonephritis on kidney biopsy.

Ureterocutaneous Fistula in the Setting of Recurrent Gluteal Abscesses: A Case Report

Ureteral fistulas are a rare occurrence that can arise from iatrogenic trauma, radiation, malignancy, and inflammation. Treatment options of urinary tract fistulas are handled on a case-by-case basis, and can necessitate a surgical approach. The authors present the case of an 85-year-old female patient with a ureterocutaneous fistula, where conservative management with percutaneous nephrostomy is a viable alternative to surgical intervention.

Effectiveness of antibiotic therapy for early recurrence of peritonsillar cellulitis and abscesses: A retrospective cohort study

ObjectiveShort-term recurrence is common in patients with peritonsillar cellulitis and abscesses, leading to socioeconomic problems. Early switching from intravenous to oral antibiotics is feasible for treating certain diseases. However, reports on early switching and total antibiotic administration duration in peritonsillar cellulitis and abscesses are limited. This study aimed to determine the appropriate antibiotic therapy duration and examine the impact of early oral switch therapy on peritonsillar cellulitis and abscesses. MethodsWe retrospectively identified 98,394 patients who received antibiotic therapy during hospitalization for peritonsillar cellulitis and abscesses between July 1, 2010, and December 31, 2019, using the Japanese Diagnosis Procedure Combination database. ResultsPropensity score matching analysis revealed no significant between-group difference in the rehospitalization rate (early oral switch therapy and long intravenous therapy: 1.7 % [198 of 11,621] vs. 2.0 % [234 of 11,621], odds ratio [OR] 0.84, 95 % confidence interval [CI] 0.70–1.02). A long total duration of antibiotic therapy (reference: 1–9 days) was associated with a low risk of rehospitalization (10–14 days: OR 0.86, 95 % CI 0.78–0.95; 15+ days: OR 0.51, 95 % CI 0.38–0.66). ConclusionEarly oral switch therapy may be a viable option for treating patients with peritonsillar cellulitis and abscesses in good condition who can tolerate oral intake. No less than 10 days of antibiotic therapy is desirable.

Optimizing theatre utilization for abscess drainage: going beyond priority categories.

Day-only emergency surgery for abscess drainage is poorly implemented in Australia. This study assessed the feasibility, outcomes, cost, and impact of an acute day-only surgery (ADOS) program. A retrospective pre-post implementation study of patients requiring abscess drainage in theatre was performed. Following implementation of an ADOS program for abscess management, eligible patients were discharged from the emergency department and prioritized first on the following day's emergency list. Outcomes from the first 12 months of the ADOS era were compared with those of the preceding 6 months (pre-ADOS). Primary outcome was length of hospital stay (LOS). Secondary outcomes included 30-day complications, admission costs, and impact on overall emergency theatre workflow (measured by emergency appendicectomy metrics). Overall, 266 patients during the ADOS era (including 95 eligible for the ADOS pathway) were compared with 115 patients during the pre-ADOS era. Baseline characteristics were comparable. Median LOS was shorter during the ADOS era (21.9 h (IQR 11.8-43.3) vs. 30.1 h (IQR 24.7-48.8), P < 0.001). Median LOS was 10.2 h (IQR 8.9-13.1) for patients on the ADOS pathway. There were no significant differences in 30-day complications (9.3% vs. 9.5%), emergency department re-presentations (7.4% vs. 5.1%), or abscess recurrence (5.6% vs. 5.7%). Average cost per patient was lower during the ADOS era ($4155 vs. $4916, p = 0.005). ADOS did not appear to materially impact other emergency procedures. ADOS for abscess drainage is feasible, safe, and produces cost savings, while being implemented without significant additional resources.

Integrative management of high transsphincteric fistula-in-ano with a rectal opening: A case report

Abstract Transsphincteric fistula is a type of complex anal fistula, often considered a refractory surgical condition, which has the potential to produce complications, such as recurrent infections, abscess formation, and incontinence. A 48-year-old male farmer was diagnosed with a high transsphincteric fistula abscess with a secondary rectal opening based on clinical examination and magnetic resonance imaging findings. Under saddle block, incision and drainage of fistula abscess was performed, followed by threading of Apamarga Kshara Sutra (medicated seton) between the abscess cavity and the primary internal opening at 6 o’clock on the dentate line. Another internal opening was also identified in the lower rectum, left as it is. Panchavalkala Kwatha for sitz bath once a day, Varunadi Kwatha 20 mL twice a day orally, Kachanar Guggulu (500 mg) two tablets three times a day, and Apamarga Kshara Tail (AKT) dressing was prescribed for 124 days to facilitate optimal healing and management. Prophylactic as well as therapeutic antibiotics and analgesics were administered for 7 days. The fistula took 103 days for complete healing with a unit healing time of 0.251 day/cm3. Medicated seton on the dentate line facilitated drainage of the infected gland and healed the secondary rectal opening. Ischiorectal abscess cavity healed by secondary intention. This case report demonstrates that a high transsphincteric fistula-in-ano with a rectal opening can be successfully managed without fistulotomy to treat the secondary rectal opening. Chemical debridement of the infected anal gland was achieved by a medicated seton, and a new seton was replaced every 7 days until the cutting and healing of the fistula track. It also facilitated the drainage of the exudate. Wound management by AKT and adjuvant medicament supported faster recovery.

Neglected Preauricular Sinus Abscess Extending to the Scalp: A Case Report of Complications and Management Challenges

Preauricular sinus, a congenital malformation resulting from incomplete fusion of the first and second branchial arches, is a relatively common condition with a reported prevalence of 0.1% to 0.9%. While mostly asymptomatic, it can lead to abscess formation when infected. We present a unique case of a neglected preauricular sinus abscess that extended to the scalp, causing significant complications. The report discusses the clinical presentation, diagnostic approach, treatment modalities, and potential complications associated with this unusual and severe presentation. Prompt and appropriate management, combined with conservative treatment and surgical intervention, led to successful outcomes. This case highlights the importance of recognizing potential risks and implementing a systematic approach in managing recurrent preauricular sinus abscesses.

MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT

Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.&#x0D; Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.&#x0D; Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.&#x0D; Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.

MULTIPLE GIANT CHALAZIA IN HYPERIMMUNOGLOBULINEMIA E SYNDROME: A CASE REPORT

Abstract&#x0D; Introduction : Hyperimmunoglobulinemia E syndrome (HIES) is a rare primary immunodeficiency disorder that manifests as elevated level of serum immunoglobulin E (IgE) higher than 1.000 IU/mL and multisystem disorder characterized by recurrent skin and pulmonary abscesses caused by autosomal dominant or recessive disorder with gene mutation. We present a case of multiple giant chalazion ina patient with HIES.&#x0D; Case Illustration : A 15-year-old boy was referred to Ophthalmology Department with multiple giant lumps on the left eyelid for the last 2 weeks. He had a history of recurrent multiple lumps on the left lower eyelid in the last 1 year. He was diagnosed with HIES since 8 years ago. He had normal visual acuity of both eyes. Multiple giant chalazion were observed on the left upper and lower eyelid. The patient also presented with scalp and neck infection. Laboratory studies showed elevated total serum IgE level of 53,032 IU/mL and eosinophilia.&#x0D; Discussion : Ocular manifestations in HIES patients are not common. Some cases reported chalazia, keratoconus, and blepharitis. Surgical incision drainage was performed in our patient. Medications and surgical intervention had produced only transient improvement. The patient was treated conservatively. Riskof chalazia recurrence remains unknown as reported cases presented with diverse clinical presentation and follow-up serum IgE evaluation is not routinely performed.&#x0D; Conclusion : Recurrent multiple giant chalazia may occur as an ophthalmic feature of HIES. HIES should be considered and investigated in patients presenting with recurrent giant chalazia.

Recurrent Orbital Subperiosteal Abscess in Patient with Nasopharyngeal Carcinoma

Introduction : Subperiosteal abscess (SPA) is a rare finding in cancer patients with orbital cellulitis. Severe complications associated with this condition are permanent visual loss, intracranial extension, and death.&#x0D; Case Illustration : A 38-year-old male with history of nasopharyngeal carcinoma (NPC) came with progressive right eyelid swelling, non-axial proptosis, and visual acuity was NLP. CT scan revealed right SPA associated with frontal sinusitis. NPC staging was T3N2M0. Despite the treatment of intravenous antibiotics and drainage incision of SPA, there was recurrence of right SPA two weeks after procedure and re-staging revealed T4N3M0. A joint operation with otolaryngology department to do debulking of the mass, frontal sinus surgery, and drainage incision was held. Culture resulted in Talaromyces marneffei. Patient was assessed with talaromycosis and given itraconazole for ten weeks. Moreover, patient came again with proptosis seven weeks postoperatively. Re-drainage incision was performed and clinical presentation was improved.&#x0D; Discussion : This case describes rare biological nature of NPC where extensive blockage of paranasal sinuses allows microorganism overgrowth and infection. The anatomical changes and cancer-related immunosuppression contribute to recurrent SPA. Chemotherapy and radiotherapy are ideal treatments for our patient, however, infection must be treated adequately first. Surgical interventionis needed to manage the infection by SPA drainage where antimicrobial has poor penetration into the abscess and debulking of tumor to clear the blockage of drainage pathway.&#x0D; Conclusion : Recurrent orbital SPA could happen in patients with NPC, therefore appropriate medical treatment and timely surgical intervention are essential in managing orbital SPA. Multidisciplinary management is required to optimize patient outcomes.

Risk factors for therapy failure after incision and drainage alone for perianal abscesses in children.

It is well known that recurrent perianal abscesses (PAs) and fistula-in-ano (FIA) are the main causes of therapy failure following incision and drainage (I&D) for PAs. But few studies have focused on the risk factors for therapy failure after I&D for PAs in children. In this study, we retrospectively examine the risk factors for therapy failure after I&D for PAs in children in a pediatric tertiary care institution. A retrospective review of all outpatient children with PA treated by I&D at Beijing Children's Hospital between January 2021 and December 2022 was performed. A follow-up was conducted in October 2023. Patients with other predisposing factors for perianal infection, such as inflammatory bowel disease, hematologic tumor, and anorectal surgery, were excluded from this study. Logistic regression yielding odds ratios (ORs) was used to assess the significance of variables for therapy failure. Of 160 children initially identified, follow-up was available for 146, with a total of 172 treatments. A total of 91% of children were male. The median (interquartile range) age at I&D was 2 (1, 15) months. The median follow-up duration was 20 (14, 25) months. Therapy failure occurred in 25 (15%) treatments performed for the prevention of recurrence of PA and in 35 (20%) treatments for the prevention of development of FIA. In the univariate analysis, a history of PA (P = 0.001), history of I&D (P = 0.014), and multilocal occurrence (P = 0.003) were associated with therapy failure. A sitz bath after I&D (P = 0.016) and regular cleaning of the wound after I&D (P = 0.024) were associated with therapy success. In the multivariate analysis, a history of PA (P = 0.015, OR = 3.374) and multilocal occurrence (P = 0.012, OR = 4.649) were independently associated with therapy failure. Regular cleaning of the wound (P = 0.017, OR = 0.341) and sitz bath (P = 0.001, OR = 0.128) after I&D were independently associated with therapy success. A history of PA and multilocal occurrence were predictor factors for therapy failure before I&D. Regular cleaning of the wound and sitz bath after I&D were protective factors for therapy success. Therefore, regular cleaning of the wound and sitz bath after I&D should be emphasized in all children with PAs, especially in those with a history of PA and multilocal occurrence.

Role of prolonged packing in postoperative anorectal abscess management: a systematic review and meta-analysis.

Prolonged packing of anorectal abscess cavities with internal dressings after incision and drainage is frequently used, but the efficacy of this practice remains controversial. Some studies highlight its use in hemostasis and preventing fistula and abscess recurrence, whereas others describe its economic burden and increase in pain. In this systematic review, we examine current evidence on the impact of packing after incision and drainage for anorectal abscesses. The medical librarian conducted a comprehensive literature search on January 5, 2023. We conducted the meta-analysis using RevMan 5.4.1 software with a Mantel-Haenszel random-effects model. We identified 3 randomized controlled trials, comprising 490 patients. Of those, 241 patients (49%) received postoperative packing; most patients were male (n = 158, 65.6%), with a median age of 40.5 years and a follow-up of 6 months. Meta-analysis showed that prolonged wound packing was associated with delayed wound healing and increased pain, but no difference in abscess recurrence or fistula formation. In this systematic review of current evidence highlighting the impact of packing after incision and drainage for anorectal abscesses, we found that the practice is not associated with significant differences in abscess recurrence and fistula formation, but is associated with increased postoperative pain and delayed wound healing.

Hyper-IgE syndrome: a case report

Introduction and importance: Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency disorder characterized by elevated serum IgE levels, recurrent infections, and various clinical features. Early diagnosis, prompt management of infections, and supportive care are essential in improving outcomes for individuals with HIES. Genetic testing, including STAT3 gene sequencing, plays a crucial role in confirming the diagnosis. Further research is needed to enhance our understanding of HIES and develop targeted therapies to improve the quality of life for affected individuals. Case presentation: This case report presents the clinical features and management of a 37-year-old male with HIES, diagnosed at the age of 2 due to recurrent cold abscesses caused by Staphylococcal infections. Clinical discussion: The patient exhibited typical symptoms of HIES, including recurrent eczema, frequent bacterial infections, mucocutaneous candidiasis, and various physical abnormalities. Diagnostic markers such as elevated IgE levels and eosinophilia supported the HIES diagnosis, which was further confirmed by the identification of a STAT3 gene mutation. Treatment primarily involved supportive measures and antibiotics for infections. The patient’s blood test results and imaging findings revealed abnormalities such as low red blood cell count, elevated erythrocyte sedimentation rate, and pulmonary nodules. Conclusion: This case report highlights the importance of early diagnosis, prompt management of infections, and the need for ongoing research to improve our understanding and treatment of HIES.