Liver abscess presentation and management in Saudi Arabia and the United Kingdom

Liver abscess [LA] is a well-described disease in the medical literature; however, information about its characteristics and outcome in the Middle East is lacking. We compared the mode of presentation, risk factors, management and outcome of LA patients in Saudi Arabia with cases from the United Kingdom [UK]. Retrospective review of LA patients from three tertiary care centers [2 from Saudi Arabia and 1 from the UK] over a period of 10 years, from 1995 to 2005. Data collected included demographic characteristics; clinical presentation; biochemical, microbiological and radiological findings; treatment modalities; and outcome. A total of 83 patients were diagnosed with LA, including 48 patients from Saudi Arabia and 35 patients from the UK. The mean [SD] age was 45.2 [20.3] years for those from Saudi Arabia and 55.4 [18.8] years for those from the UK [P=.022]. The majority of the patients were males [70% from Saudi Arabia and 80% from the UK]. Upper abdominal pain and fever were the commonest symptoms, each reported in 87% of the cases. Alkaline phosphatase elevation was the commonest liver function abnormality, seen in 66 [80%] patients. Organisms were isolated in 43 [52%] cases and the majority of these were coliforms [58%]. Amebic liver abscesses occurred in 19 [23%] patients and all of those patients were either from or had traveled recently to the Indian subcontinent. Complete resolution of the abscesses was achieved in 66 [80%] patients with aspiration and/or antibiotics, and 9 [10.8%] patients died. On multivariate analysis, underlying malignancy, hypotension and chest signs at presentation were predictors of poor outcome [P=.008, .029 and .001, respectively]. Successful resolution of LA is achievable in the majority of the cases, although underlying malignancy is associated with poor outcome. Amebic liver abscesses must be considered in patients with a history of travel to endemic areas

Coincidence of acute brucella hepatitis and dengue fever or serologic cross-reactivity?

Hepatic involvement in brucellosis is not uncommon since 10-20% of patient infected with brucella species can have abnormal liver function tests. The usual presentation of brucella hepatitis is in the form of chronic granulomatous hepatitis with mild to moderate elevation of liver enzymes, while acute hepatitis is rare. We report a young patient who presented with acute brucella-induced hepatitis and co-infection with dengue hemorrhagic virus resulting in severe elevation of liver enzymes and absence of granuloma on histology. His mother also simultaneously tested positive for both infections. The patient responded well to anti-brucella therapy with normalization of his liver profile. We discuss, herein, the hepatic involvement of these two infections and discuss the possible serological cross-reactivity between brucella and dengue fever virus