Recurrent Liver Abscess in a Non-Toxic Patient
American Journal of Gastroenterology
; 117(10 Supplement 2):S2025, 2022.
Article
in English
| EMBASE | ID: covidwho-2324085
ABSTRACT
Introduction:
Liver abscesses are caused by direct spread from peritonitis, biliary tract infection or via hematogenous seeding from a distant source. Most are polymicrobial, however Escherichia coli and Klebsiella pneumoniae are the most common offending pathogens. Patients usually present with pain, fever, and clinical signs of infection. We describe a case of spontaneous liver abscess in a non-toxic patient that recurred 10 years after a previous abscess. Case Description/Methods:
A 73-year-old-man with a history of type 2 diabetes mellitus, hypertension, CAD status post CABG and PCI 3 years ago, and abdominal aortic aneurysm status post endovascular aneurysm repair presented with 2 weeks of dark urine. After receiving his COVID-19 booster and influenza vaccinations, he developed flu-like symptoms with a self-resolving fever of 101.8degreeF. He had dark amber urine without dysuria or hematuria. Later, he experienced generalized weakness and decreased oral intake. Outpatient labs showed elevated liver function tests, and he was told to present to the ED. On arrival, he was afebrile with stable vitals. Physical exam was unremarkable. Laboratory evaluation showed a hemoglobin of 11.7 g/dL, sodium of 133 mEq/L, creatinine of 1.4 mg/dL, aspartate aminotransferase of 117 U/L, alanine aminotransferase of 212 U/L, alkaline phosphatase of 825 U/L, total bilirubin of 4.1 mg/dL, and direct bilirubin of 2.1 mg/dL. Triple-phase CT showed a 2.8 cm mass in the right liver lobe with linear enhancement. Ultrasound showed mixed echogenicity measuring 3.6 x 2.9 x 3.3 cm in segment 8 of the liver. On further evaluation, patient had an E. coli abscess diagnosed 10 years prior, managed with antibiotics and drainage. At that time, the abscess was within the right inferior liver lobe, similar to his current abscess. LFTs downtrended. Abscess was aspirated, with culture growing oxidase negative, gramnegative rods, likely E. coli. Patient started on ceftriaxone and metronidazole, to undergo colonoscopy as an outpatient and rule out colonic bacterial translocation. Discussion(s) Pyogenic liver abscess can result in significant morbidity and mortality because of worsening infection and sepsis. Abscesses occur because of spread from adjacent infection or after recent surgeries. Recurrence is very rare. Here, we describe a very unusual case of a pyogenic liver abscess growing E. coli in a non-toxic patient, with the same location and causative organism as an abscess managed 10 years prior. (Figure Presented).
abdominal aortic aneurysm; aged; alanine aminotransferase blood level; asthenia; bacterial translocation; bacterium culture; case report; clinical article; clinical evaluation; colonoscopy; conference abstract; coronavirus disease 2019; diabetes mellitus; drug combination; drug therapy; dysuria; endovascular aneurysm repair; Escherichia coli; fever; flu like syndrome; hematuria; human; human tissue; hypertension; influenza vaccination; liver abscess; liver function test; liver lobe; male; morbidity; mortality; non insulin dependent diabetes mellitus; nonhuman; outpatient; physical examination; pyogenic liver abscess; right liver lobe; sepsis; surgery; ultrasound; alanine aminotransferase; alkaline phosphatase; amber; antibiotic agent; aspartate aminotransferase; bilirubin; bilirubin glucuronide; ceftriaxone; creatinine; endogenous compound; hemoglobin; metronidazole; oxidoreductase; sodium
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
/
Prognostic study
Topics:
Vaccines
Language:
English
Journal:
American Journal of Gastroenterology
Year:
2022
Document Type:
Article
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