Liver abscess due to Granulicatella adiacens in an immunocompetent patient: Case report / Absceso hepático por Granulicatella adiacens

Pyogenic liver abscesses due to Granulicatella adiacens are infections associated with high mortality, mainly in immunocompromised patients. The main microorganisms associated with liver abscesses are Klebsiella pneumoniae, and Escherichia coli, though it may also be polymicrobial. However, case reports describing liver infection by Granulicatella adiacens are scarce. We present the case of an immunocompetent adult patient who presented 15 days of evolution consisting of quantified fever peaks associated with asthenia, adynamia, chills, jaundice and coluria. The initial clinical examination revealed a generalized icteric tint without abdominal pain, and blood pressure with a tendency to hypotension. Biliopancreatic confluent neoplasia, secondary cholangitis and sepsis of biliary origin were suspected, initiating fluid resuscitation and antibiotic therapy; blood cultures and complementary diagnostic studies were taken. Hepatobiliary ultrasound with evidence of an abscess of 73 x 62 mm in segment IV; the bile duct and pancreas were within normal limits. To better characterize the lesion evidenced in the liver, a contrast-enhanced computed tomography of the abdomen was performed. The patient completed antibiotic management with ciprofloxacin, vancomycin, and metronidazole in good condition and was successfully discharged. This is the first pyogenic liver abscess reported caused by Granulicatella adiacens in an immunocompetent patient, in whom early microbiological diagnosis in conjunction with targeted antibiotic treatment and percutaneous drainage of the lesion was decisive in the clinical outcome.

Los abscesos hepáticos piógenos por Granulicatella adiacens son infecciones asociadas a una alta mortalidad, principalmente en pacientes inmunocomprometidos. Los principales microorganismos asociados a los abscesos hepáticos son Klebsiella pneumoniae y Escherichia coli, aunque pueden ser polimicrobianos. Sin embargo, los informes de casos que describen la infección hepática por G. adiacens son muy escasos. Se presenta el caso de un paciente adulto inmunocompetente que presentó 15 días de evolución de picos febriles cuantificados asociados a astenia, adinamia, escalofríos, ictericia y coluria. El examen clínico inicial reveló un tinte ictérico generalizado sin dolor abdominal, y presión arterial con tendencia a la hipotensión. Se sospechó neoplasia biliopancreática confluente, colangitis secundaria y sepsis de origen biliar, y se inició reanimación con líquidos y antibioterapia. Se tomaron hemocultivos y estudios diagnósticos complementarios. En el ultrasonido hepatobiliar, se observó un absceso de 73 x 62 mm en el segmento IV; la vía biliar y el páncreas se encontraron dentro de los límites normales. Se realizaron múltiples pruebas moleculares de detección de microorganismos (FilmArray), y se identificó a G. adiacens como el principal agente patógeno. El paciente completó el manejo antibiótico con ciprofloxacina, vancomicina y metronidazol en buenas condiciones y fue dado de alta con éxito. Este es el primer absceso hepático piógeno reportado causado por G. adiacens en un paciente inmunocompetente, en quien el diagnóstico microbiológico temprano en conjunto con el tratamiento antibiótico dirigido y el drenaje percutáneo de la lesión fueron determinantes en el resultado clínico.

Two cases of brucellosis complicated with liver abscess or pancytopenia / 中华全科医师杂志

Two brucellosis patients with rare complications are presented in this report. In case 1, abdominal CT showed two liver abscesses with the maximum diameter>5.0 cm, no puncture and drainage were given. After treatment with anti brucellosis drugs, the abscess lesions disappeared completely. Case 2 had pancytopenia, the platelet count was reduced to 14×10 9/L. After anti brucellosis drug treatment the peripheral blood routine returned to normal. These two cases of rare complications of brucellosis suggests that early identification, diagnosis and treatment can improve the clinical outcomes of the patients.

Difficulties in diagnosis and treatment of pyogenic liver abscess / 中华肝胆外科杂志

Klebsiella pneumoniae liver abscess accompanied by metastatic infectious complications was firstly reported in 1986. The pathogen was defined as Hypervirulent K. pneumoniae (hvKp) after a series of studies, which is an evolving pathotype and more virulent than classical K. pneumoniae (cKp). At present, it is difficult to distinguish hvKp and cKp in the clinical microbiology lab, which results in delay in early diagnosis and treatment on hvKp-related infections. Biliary tract diseases after cholangiojejunostomy, biliary interventional therapy and liver transplantation have become common causes of recurrent acute cholangitis. The incidence of bacterial liver abscess is on the rise, especially the infection caused by multidrug-resistant bacteria. This article reviews difficulties in the diagnosis and treatment of bacterial liver abscess.

Morphological characteristics of liver abscesses according its etiology / Características morfológicas de los abscesos hepáticos según su etiología

Although infrequent in the diagnostics areas, liver abscesses are of significant relevance, which is related to the high morbidity and mortality figures they can cause if they are not detected and treated in time. Although multiple operational classifications are described, the one most recognized for its usefulness is that related to its causative agent (pyogenic or bacterial infection, hydatid origin or secondary to infected hydatidosis, and amoebic or by invasive amebiasis). The objective of this article was to generate a study report regarding the morphological characteristics of liver abscesses, characterizing them according to their etiology, as well as describing their study and the latest recommended treatments.

Los abscesos hepáticos son entidades nosológicas de baja frecuencia, pero de significativa relevancia, la que se relacionada con las elevadas cifras de morbilidad y mortalidad que pueden causar si no son detectados y tratados a tiempo. Si bien se describen múltiples clasificaciones operacionales, aquella más reconocida por su utilidad es la relacionada a su agente causal (piógenos o bacterianos, hidatídicos o secundarios a hidatidosis infectada, y amebianos o por amebiasis invasora). El objetivo de este artículo fue generar un documento de estudio respecto de las características morfológicas de los abscesos hepáticos, caracterizándolos de acuerdo con su etiología, así como describir su estudio y tratamiento recomendado de acuerdo con el estado del arte.

Absceso hepático piógeno en pediatría: serie de casos / Pyogenic liver abscess in children: a case series

El absceso hepático es un reto diagnóstico y terapéutico. Es una patología poco frecuente en la niñez que predomina en países en desarrollo y se asocia a malnutrición y parasitosis. El absceso hepático piógeno es el más frecuente, es una causa de hospitalización prolongada por el requerimiento de antimicrobianos endovenosos; usualmente con baja mortalidad. A continuación, presentamos una serie de cuatro casos clínicos de pacientes con abscesos hepáticos piógenos que fueron manejados entre el 2016 y 2018 en el Hospital de Especialidades Pediátricas. Tres pacientes fueron del sexo femenino y uno masculino. En dos de los pacientes se identi có factor predisponente: diabetes mellitus e infección avanzada por VIH. Los síntomas más frecuentes fueron ebre (100%), dolor abdominal (100%) y hepatomegalia (50%). En ninguno de los casos se sospechó absceso hepático a su ingreso. Los casos fueron diagnosticados por sonograma hepático y corroborados con tomografía abdominal. El tamaño promedio de las lesiones fue de 6.88 x 6.18 x 6.12 cm. Tres fueron de localización derecha y uno de localización izquierda. Todos los pacientes recibieron antibioticoterapia de amplio espectro y drenaje percutáneo. Se identi có agente etiológico en uno de los pacientes: Staphylococcus aureus. Los pacientes recibieron una media de 33 + 3.5 días de tratamiento. Con evolución favorable en todos los casos y mejoría en seguimiento con ultrasonidos. Ningún paciente requirió intervención quirúrgica.

The liver abscess involves an authentic diagnostic and therapeutic challenge. It is not frecuent in childhood. Occurs mainly in developing countries and is associated to malnutrition and parasitic infection, that are described as risk factors. Pyogenic liver abscess represents, in most of the cases, a cause of long-time hospitalizations because of the requirement of endovenous treatment, but usually with low mortality. We describe a four-case series of patients with pyogenic liver abscess between 2016 and 2018 in Hospital de Especialidades Pediatricas in Panamá City. Three patients were female and one was a male. In two of the cases, there were risk factors such as diabetes mellitus and advanced HIV infection. The most frequent symptoms were: fever (100%), abdominal pain (100%) and hepatomegaly (50%). In neither one of the cases, liver abscess was suspected as diagnosis. All cases were diagnosed by hepatic sonogram and con rmed by abdominal CT- scan. The mean size of lesions was 6.88 x 6.18 x 6.12 cm. Three of the cases were located in right lobe and one in the left lobe of the liver. They were managed with broad-spectrum antibiotics and percutaneous drainage. Staphylococcus aureus was isolated in one case. The patients received a mean of 33 + 3.5 days of treatment. All cases evolved well with improvement of lesion in ultrasonography. None of the patients required surgical intervention.

Two cases of pyogenic liver abscess due to Klebsiella pneumoniae in immunocompetent children

Pyogenic liver abscess (PLA) can be caused by bacteria entering the liver via the portal vein or primary bacteremia, or it can be cryptogenic. Recently, Klebsiella pneumoniae has been increasingly found as a PLA pathogen. PLA due to this bacterium often leads to formation of extrahepatic abscesses. The treatment of choice is dual therapy with insertion of percutaneous catheter drainage and antibiotic therapy. We report 2 cases of PLA due to K. pneumoniae in immunocompetent children. We successfully treated patient 1 with percutaneous catheter drainage for 18 days and 6-week course of antibiotic therapy. Patient 2 was treated with percutaneous needle aspiration and antibiotic therapy for the same period. In both patients, the PLAs showed the ultrasound-confirmed resolutions after the dual therapy.

Clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin / 临床肝胆病杂志

@#ObjectiveTo investigate the clinical features of diabetic patients with bacterial liver abscess and different levels of glycosylated hemoglobin (HbAlc). MethodsA total of 118 adult diabetic patients with bacterial liver abscess who were admitted to our hospital from December 2014 to December 2018 were enrolled, and according to the level of HbAlc, they were divided into well-controlled group with 32 patients, fairly-controlled group with 31 patients, and poorly-controlled group with 55 patients. The three groups were compared in terms of general data, clinical manifestations, laboratory results, complications, and pathogen test results. A one-way analysis of variance was used for comparison of continuous data between multiple groups, and the least significant difference t-test was used for further comparison between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups. ResultsThere were significant differences in mean age and length of hospital stay between the three groups (F=2.933 and 3.310, both P＜0.05). Compared with the other two groups, the poorly-controlled group had a significantly younger mean age of onset (P=0.016) and a significantly longer length of hospital stay (P=0.044). Hypertension was the most common underlying disease in diabetic patients with liver abscess, followed by biliary tract diseases and cerebral infarction, and there was a significant difference in cerebral infarction between the three groups (χ2=6.135, P=0037). Compared with the well-controlled group, the poorly-controlled group had significantly fewer and less typical signs of abdominal tenderness (χ2=6.178, P=0.046), and compared with the other two groups, the poorly-controlled group tended to have a significant increase in C-reactive protein (χ2=5.985, P=0.049) and were more likely to develop sepsis (χ2=6.247, P=0.044). ConclusionFor diabetic patients with bacterial liver abscess, the patients with a poorly controlled HbAlc level often have a young age of onset, a long length of hospital stay, and atypical clinical signs and are likely to develop sepsis, which may lead to insufficient attention in clinical practice, delay diagnosis and treatment, and even endanger life, and therefore, such patients should be taken seriously in clinical practice.

Clinical observation of venenum bufonis combined with antibiotics in the treatment of bacterial liver abscess / 中国基层医药

Objective To evaluate the clinical effect of venenum bufonis combined with antibiotics in the treatment of bacterial liver abscess .Methods 60 patients with bacterial liver abscess were enrolled ,and all patients took percutaneous transhepatic puncture guided by ultrasound .They were randomly divided into two groups according to the digital table ,30 cases in each group .The control group received antibiotics treatment ,and the treatment group received venenum bufonis plus antibiotics intravenous drip ,once daily ,one course of treatment lasted seven days .The body temperature , blood routine , procalcitonin and other project changes of the two groups were detected .Results Compared with the control group,the effective rate of the treatment group was higher (96.7％ vs.80.0％,χ2 =4.043,P=0.044).In the treatment group,the time of body temperature returning to normal [(7.00 ±1.67)d vs. (9.00 ±1.41)d],leukocyte recovery time [(7.83 ±2.32) d vs.(9.82 ±1.94) d],procalcitonin recovery time [(7.00 ±1.67)d vs.(9.00 ±1.41)d],symptom disappearance time [(5.17 ±1.72)d vs.(7.50 ±1.87)d],disap-pearance time of abscess[(12.00 ±3.41)d vs.(16.00 ±2.37)d]were shorter than those in the control group(t=-2.601,-2.890,-2.236,-2.248,-2.362,P=0.026,0.016,0.049,0.044,0.041).Conclusion Venenum bufonis combined with antibiotics can significantly increase the curative rate and accelerate infection control , there-fore,it is worthy of popularizing in clinical practice .

Ruptured Gas-forming Pyogenic Liver Abscess into the Peritoneal Cavity Treated Successfully with Medical Treatment / 대한소화기학회지

Gas-forming pyogenic liver abscess (GFPLA) is very rare and has a very high mortality in case of rupture into the abdominal cavity, which usually require surgical treatment. We experienced a case of a ruptured GFPLA due to Klebsiella pneumoniae complicated with peritonitis and sepsis in a 68-year-old diabetic woman. Immediate and aggressive medical treatments including intravenous antibiotics, percutaneous drainage, and continuous renal replacement therapy dramatically improved the liver abscess, peritonitis, and metabolic problems. We report an unusual case of a ruptured GFPLA without surgical management, treated successfully with only medical treatment.

A Case of Advanced Gastric Cancer Concomitant with Pyogenic Liver Abscess in the Patient with Subtotal Gastrectomy / 대한소화기학회지

The hematogenous spreading of an infectious pathogen via the portal vein from a mucosal injury in the gastrointestinal tract has been considered as one of the pathologic mechanisms of pyogenic liver abscess. Several studies have presented the association between colorectal cancer and pyogenic liver abscess. However, the cases of stomach cancer concomitant with pyogenic liver abscess have rarely been reported in the world. Herein, we present a case of advanced gastric cancer concomitant with pyogenic liver abscess in a patient who previously underwent subtotal gastrectomy due to peptic ulcer perforation.

Recurrent pyogenic liver abscess as a presenting manifestation of colorectal cancer

No abstract available.

The Prevalence of Colonic Neoplasm in Cryptogenic Pyogenic Liver Abscess: A Prospectively Enrolled Cross-sectional Study / 대한소화기학회지

BACKGROUND/AIMS: Several studies suggest that pyogenic liver abscess (PLA) is associated with colon neoplasm. A colonoscopic exam for cryptogenic PLA might detect a hidden colon neoplasm, through which intestinal flora can be transmitted into the liver. However, there are no prospectively enrolled cross-sectional data for colonic neoplasm in cryptogenic PLA. METHODS: Patients with PLA were prospectively enrolled from two university hospitals. Among them, all the patients with cryptogenic PLA were recommended for colonoscopic exam to check for colonic neoplasm. RESULTS: One hundred eighty-three patients with PLA were enrolled in the study for 22 months. One hundred and one (55.2%) patients did not have a definite cause of liver abscess at initial evaluation. The median diameter of the largest lesion was 5.7 cm (1.0-14.0 cm), and 74.3% of the patients were treated by percutaneous abscess drainage. Ninety-one percent of the patients who had an identified pathogen yielded Klebsiella. Sixty-two patients underwent colonoscopic exams, and no one had a colonic cancer, one had an adenomatous polyp with high grade dysplasia (1.6%), and 27 had adenomatous polyps with low grade dysplasia (43.5%; 41.0% in male and 43.5% in female). Of fifty patients who underwent an esophagogastroduodeno-scopic exam, nine had gastric ulcers, one had an esophageal ulcer, and one had hemorrhagic gastritis. CONCLUSIONS: The prevalence of colonic neoplasm among the patients with cryptogenic PLA was not as high as that in previous studies. Further well-designed, large-scale studies are required to assess the association of the colon neoplasm and cryptogenic PLA.

A Case of Delayed-onset Multiple Metastatic Infection following Liver Abscess / 대한소화기학회지

Klebsiella pneumoniae liver abscess has a tendency to spread to distant sites early in the course of disease and to involve multiple organs synchronously. A 59-year-old male was admitted because of liver abscess accompanied by fever and abdominal pain. The patient underwent percutaneous catheter drainage and received intravenous antibiotics. Symptom relief was achieved after the treatment as well as marked reduction in the size of the abscess. Despite proper treatment of the liver abscess, however, patient developed multiple metastatic infections in a non-concurrent manner: left and right endophthalmitis, psoas abscess, and infectious spondylitis at 5, 23, 30 and 65 days after initial manifestations of liver abscess, respectively. Each infectious episode followed one another after resolution of the former one. For each episode of metastatic infections, the patient promptly underwent treatment with systemic and local antibiotics, interventional abscess drainage, and surgical treatments as needed. The patient fully recovered without sequelae after the use of intravenous antibiotics for an extended period of time. Herein, we report a case of K. pneumoniae liver abscess complicated with delayed-onset multiple metastatic infections.

Diagnosis and treatment of pyogenic liver abscess in elderly patients by multislice CT / 临床肝胆病杂志

ObjectiveTo review the multislice computed tomography (MSCT) characteristics and treatment of pyogenic liver abscess in elderly patients. MethodsA retrospective analysis was performed on the clinical data of 42 elderly patients who were diagnosed with pyogenic liver abscess in our hospital from March 2001 to February 2014. The MSCT characteristics and clinical treatment of this disease were reviewed. Comparison between two groups was made by t test. ResultsAmong the 42 patients, 37 had the liver abscess in the right lobe, and 5 in the left lobe; 33 had single lesions, and 9 had grid- or honeycomb-like lesions. MSCT scan showed that all lesions had a lower density compared with normal hepatic tissues, and the CT values were approximately 6-40 Hu. In the arterial phase, 39 patients had lesions with peripheral rim enhancement, and 3 had no edge enhancement. Conservative treatment was given to 15 patients, among whom the diameter of abscess was 3.7±2.1 cm, the duration of fever was 11.7±4.1 d, and the average hospital stay was 22.6±5.3 d. Percutaneous drainage was performed in 27 patients, among whom the diameter of abscess was 6.3±2.8 cm, the duration of fever was 7.1±2.2 d, and the average hospital stay was 13.7±3.1 d. There were significant differences in the diameter of abscess, the duration of fever, and the length of hospital stay between the two groups (P=0.021, 0.026, and 0.006, respectively). ConclusionMSCT can accurately reveal the location and morphology of abscess, and correct diagnosis can be made in combination with the patient's medical history. Drainage guided by ultrasound or CT is an effective, minimally invasive, and safe treatment for controlling fever and promoting fast recovery in the elderly.

Comparisons of the clinical effectiveness between ultrasound-guided puncture drainage and open surgery in the treatment of pyogenic liver abscess / 中华普通外科杂志

Objective To compare the clinical effectiveness between puncture drainage and surgery in the treatment of pyogenic liver abscess.Methods Clinical date of 81 patients with pyogenic liver abscess were retrospectively analyzed.Patients were divided into the ultrasound-guided puncture drainage group (48 patients) and open surgical drainage group (33 patients).The demographic data,laboratory examination,efficient rate,complication rate,mortality,time for body temperature returned to normal and hospital stays were compared between the two groups.Results Klebsiella pneumoniae was positive in 45.45％ cases by blood culture,and in 62.50％ cases by pus culture.There was no statistically significant difference in the effective rate and mortality (x2 =0.91,2.05,P ＞ 0.05).For patients with puncture drainage hospital stay was (14 ± 5) days,significantly shorter than (17 ± 5) days in surgery group (t =-3.20,P ＜ 0.05).Time to normal temperature was (5.1 ± 1.6) days in puncture drainage group,which was shorter than (6.0 ± 1.1) days in open surgery group (t =-2.85,P ＜ 0.05).Postoperative complications were fewer in the puncture drainage group (6 cases) than open surgery group (10 cases) (x2=3.91,P ＜ 0.05).Conclusions Ultrasound-guided puncture drainage for liver abscess is safe,feasible,effective of low complication rate for the treatment of pyogenic liver abscess.

Diagnosis and treatment of pyogenic liver abscess in elderly patients by multislice CT / 临床肝胆病杂志

Objective To review the multislice computed tomography (MSCT)characteristics and treatment of pyogenic liver abscess in elderly patients.Methods A retrospective analysis was performed on the clinical data of 42 elderly patients who were diagnosed with pyo-genic liver abscess in our hospital from March 2001 to February 2014.The MSCT characteristics and clinical treatment of this disease were reviewed.Comparison between two groups was made by t test.Results Among the 42 patients,37 had the liver abscess in the right lobe, and 5 in the left lobe;33 had single lesions,and 9 had grid-or honeycomb-like lesions.MSCT scan showed that all lesions had a lower density compared with normal hepatic tissues,and the CT values were approximately 6 -40 Hu.In the arterial phase,39 patients had le-sions with peripheral rim enhancement,and 3 had no edge enhancement.Conservative treatment was given to 15 patients,among whom the diameter of abscess was 3.7 ±2.1 cm,the duration of fever was 11.7 ±4.1 d,and the average hospital stay was 22.6 ±5.3 d.Percutane-ous drainage was performed in 27 patients,among whom the diameter of abscess was 6.3 ±2.8 cm,the duration of fever was 7.1 ±2.2 d, and the average hospital stay was 13.7 ±3.1 d.There were significant differences in the diameter of abscess,the duration of fever,and the length of hospital stay between the two groups (P=0.021,0.026,and 0.006,respectively).Conclusion MSCT can accurately reveal the location and morphology of abscess,and correct diagnosis can be made in combination with the patient's medical history.Drainage guided by ultrasound or CT is an effective,minimally invasive,and safe treatment for controlling fever and promoting fast recovery in the elderly.

Absceso hepático piógeno. Presentación de caso / Pyogenic Liver Abscess. A Case Report

Los abscesos hepáticos representan el 13 % de todos los abscesos abdominales y el 48 % de los viscerales; los de origen bacteriano o abscesos hepáticos piógenos son los más frecuentes. Se presenta el caso de una mujer de 34 años, mestiza, con antecedentes de haber presentado litiasis vesicular(2011), ictericia obstructiva extrahepática por litiasis coledociana(mayo de 2012), colangitis posterior a colangiopancreatografía retrógrada endoscópica y colecistectomía (agosto de 2012) por litiasis vesicular. En septiembre de 2012, comenzó a presentar diariamente fiebres altas, con escalofríos, generalmente por las tardes; sudoraciones nocturnas, inapetencia, pérdida de peso, nauseas y dolor en el cuadrante superior derecho del abdomen, a veces intenso, mantenido y molesto. La clínica, los antecedentes, la ecografía y la tomografía axial computarizada multicorte confirmaron el diagnóstico de abscesos hepáticos piógenos. Quedaron bien identificados los factores de riego que propiciaron la infección. La paciente evolucionó satisfactoriamente con tratamiento médico.

Liver abscesses account for 13% of all abdominal abscesses and 48% of those occurring in the viscera. The bacterial or pyogenic liver abscesses are the most frequent. A case of a 34-year-old woman of mixed race with history of gallstones (2011), extrahepatic obstructive jaundice caused by cholelithiasis (May 2012), cholangitis after endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy (August 2012) due to gallstones is presented. In September 2012, she began suffering from high fever with chills every day, usually in the evenings. In addition, she presented night sweats, loss of appetite, weight loss, nausea and pain in the right upper quadrant of the abdomen which was sharp, permanent and annoying sometimes. The signs and symptoms, history, ultrasound scan and multislice computed tomography confirmed the diagnosis of pyogenic liver abscess. The risk factors leading to the infection were well-identified. The patient progressed satisfactorily with the medical treatment provided.

A Case of Pyogenic Liver Abscess Complicating Cardiac Tamponade Caused by Klebsiella pneumoniae / 대한내과학회지

An 83-year-old female patient visited the emergency department for abdominal pain and dyspnea with hemodynamic instability. Abdominal computed tomography showed multiple liver abscesses and a large volume of pericardial effusion. A transthoracic echocardiography revealed features suggestive of cardiac tamponade, including massive pericardial effusion and diastolic collapse of the right atrial wall. Emergency percutaneous pericardial drainage and percutaneous transhepatic drainage were performed. Klebsiella pneumoniae (KP) was isolated from both the pericardial effusion and bile. The first case of cardiac tamponade secondary to a liver abscess in Korea was reported in 1981, and it was caused by amoebal infection via fistula formation between the pericardium and abscess. We recently experienced a case of pyogenic liver abscess caused by KP complicating cardiac tamponade via direct invasion. This is an unusual complication of KP infection because KP is more frequently associated with hematogenous spread.

A Case of Sudden Onset Septicemia in Recurred Gastric Cancer Following S1 Plus Docetaxel Treatment

Pyogenic liver abscess in patients with malignant disease is a fatal state and is easily diagnosed. We presented a rare case of sudden fatal septicemia following anticancer treatment for recurred gastric cancer due to multiple liver abscesses which could not be diagnosed. A 72-year-old male with recurred gastric cancer received anticancer agents. He had a history of distal gastrectomy with right hepatic lobectomy for hepatic metastasis. He received anticancer treatment in the outpatient's service center periodically, and his performance status was preserved with nothing in particular. After administrating docetaxel, he suddenly developed septicemia and multiple organ failure and died 5 days after strong medical supports. Pathological autopsy revealed that multiple minute abscesses of the liver which could not be detected macroscopically were the causes of fatal septicemia. The etiology, therapies and prognosis of rare entity are being discussed.

CT Manifestations and Drainage Characteristics of Klebsiella Pneumoniae Induced Liver Abscess / 中国医学影像学杂志

Purpose To analyze the differences of CT manifestations, and to explore the disparity of drainage volume in early drainage between Klebsiella pneumoniae induced liver abscess and non-Klebsiella pneumoniae induced liver abscess. Materials and Methods 337 cases of patients whose blood culture or drainage fluid culture results were positive were divided into Klebsiella pneumoniae group (219 cases) and non-Klebsiella pneumoniae group (118 cases). CT characteristics of the two groups were analyzed, including lesion distribution, quantity, structure, texture, abscess wall thickness, enhancement character around the lesion, whether or not concurrent with thrombophlebitis or migratory infection and so on. Early drainage volume in interventional puncture drainage was observed in both groups. Results Chest CT showed that solitary, multi-room, solid, thin-walled abscesses with concurrent thrombophlebitis, migratory infection and no enhancement around tend to occur in Klebsiella pneumoniae group (χ2=4.065, 3.834, 4.682, 5.689, 5.215, 8.362, 8.407, P<0.01). Early drainage volume of Klebsiella pneumoniae group was significantly lower than that of non-Klebsiella pneumoniae group (χ2=5.863, P<0.01). Conclusion CT manifestations of Klebsiella pneumoniae induced liver abscess are solitary, multi-room, solid, thin-walled abscesses without enhancement around them, thrombophlebitis and migratory infection are common seen and drainage volume is less in early stage after interventional operation.