Unusual Presentation of Pyogenic Liver Abscess in a Healthy Young Pilot: A Case Report

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Abstract

Pyogenic liver abscess is a very rare, yet serious, condition, usually accompanied by different risk factors. In this article, we present the case of pyogenic liver abscess in an otherwise healthy male patient. What makes our patient's case unique is the fact that he does not have any past medical history and initially had very vague symptoms that were not very consistent with a diagnosis of a liver lesion, hence the delay in further testing and the conclusion of liver abscess diagnosis. Treatment includes draining of the abscesses, as well as a course of antibiotics. It is important to perform a comprehensive check-up after a liver abscess diagnosis, as it usually indicates an underlying disease. Early management is crucial to reduce the morbidity and mortality associated with the condition.

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Pyogenic liver abscess: recent trends in etiology and mortality.

Joseph Rahimian, Robert Holzman, Valerie Oram … (2004)

Pyogenic liver abscess, a potentially life-threatening disease, has undergone significant changes in epidemiology, management, and mortality over the past several decades. We reviewed the data for patients admitted to Bellevue Hospital and New York University Downtown Hospital (New York, New York) over a 10-year period. Of 79 cases reviewed, 43% occurred in patients with underlying biliary disease. The most common symptoms were fever, chills, and right upper quadrant pain or tenderness. The most common laboratory abnormalities were an elevated white blood cell count (in 68% of cases), temperature >or=38.1 degrees C (90%), a low albumin level (70.2%), and an elevated alkaline phosphatase level (67%). Seventy percent of the abscesses were in the right lobe, and 77% were solitary. Klebsiella pneumoniae was identified in 41% of cases in which a pathogen was recovered. Eighteen (50%) of 36 Asian patients had K. pneumoniae isolated, in contrast to 6 (27.3%) of 22 non-Asian patients (not statistically significant). Fifty-six percent of cases involved treatment with percutaneous drainage. Although prior reports noted mortality of 11%-31%, we observed only 2 deaths (mortality, 2.5%). The data suggest that K. pneumoniae has become the predominant etiology of pyogenic liver abscess and that mortality from this disease has decreased substantially.

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Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

Simon C H Yu, Simon S M Ho, Wan Y Lau … (2004)

This study aims to compare the therapeutic effectiveness of continuous catheter drainage versus intermittent needle aspiration in the percutaneous treatment of pyogenic liver abscesses. Over a 5-year period, 64 consecutive patients with pyogenic liver abscess were treated with intravenous antibiotics (ampicillin, cefuroxime, and metronidazole) and randomized into two percutaneous treatment groups: continuous catheter drainage (with an 8F multi-sidehole pigtail catheter); and intermittent needle aspiration (18G disposable trocar needle). There was no statistically significant difference between the two groups regarding patient demographics, underlying coexisting disease, abscess size, abscess number, number of loculation of abscess, the presenting clinical symptoms such as fever, abdominal pain, and pretreatment liver function test. Although not statistically significant, the duration of intravenous antibiotics treatment before percutaneous treatment was longer with the catheter group, and the change of antibiotics after the sensitivity test was more frequent with the needle group. The needle group was associated with a higher treatment success rate, a shorter duration of hospital stay, and a lower mortality rate, although this did not reach statistical significance. In conclusion, this study suggests that intermittent needle aspiration is probably as effective as continuous catheter drainage for the treatment of pyogenic liver abscess, although further proof with a large-scale study is necessary. Due to the additional advantages of procedure simplicity, patient comfort, and reduced price, needle aspiration deserves to be considered as a first-line drainage approach.

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Modern management of pyogenic hepatic abscess: a case series and review of the literature

Helen M. Heneghan, Nuala A Healy, Sean Martin … (2011)

Background Pyogenic hepatic abscesses are relatively rare, though untreated are uniformly fatal. A recent paradigm shift in the management of liver abscesses, facilitated by advances in diagnostic and interventional radiology, has decreased mortality rates. The aim of this study was to review our experience in managing pyogenic liver abscess, review the literature in this field, and propose guidelines to aid in the current management of this complex disease. Methods Demographic and clinical details of all patients admitted to a single institution with liver abscess over a 5 year period were reviewed. Clinical presentation, aetiology, diagnostic work-up, treatment, morbidity and mortality data were collated. Results Over a 5 year period 11 patients presented to a single institution with pyogenic hepatic abscess (55% males, mean age 60.3 years). Common clinical features at presentation were non-specific constitutional symptoms and signs. Aetiology was predominantly gallstones (45%) or diverticular disease (27%). In addition to empiric antimicrobial therapy, all patients underwent radiologically guided percutaneous drainage of the liver abscess at diagnosis and only 2 patients required surgical intervention, including one 16-year old female who underwent hemi-hepatectomy for a complex and rare Actinomycotic abscess. There were no mortalities after minimum follow-up of one year. Conclusions Pyogenic liver abscesses are uncommon, and mortality has decreased over the last two decades. Antimicrobial therapy and radiological intervention form the mainstay of modern treatment. Surgical intervention should be considered for patients with large, complex, septated or multiple abscesses, underlying disease or in whom percutaneous drainage has failed.

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Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 20 February 2025

Publication date (Electronic, collection): February 2025

Volume: 17

Issue: 2

Electronic Location Identifier: e79361

Affiliations

[1 ] Internal Medicine, American Hospital Dubai, Dubai, ARE

[2 ] General Internal Medicine, American Hospital Dubai, Dubai, ARE

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Roukia Y. Boucherabine r.boucherabine@ 123456gmail.com

Article

DOI: 10.7759/cureus.79361

PMC ID: 11930786

PubMed ID: 40130104

SO-VID: e6c102b8-e537-44c4-8212-6e0d79626384

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This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Date accepted : 20 February 2025

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Unusual Presentation of Pyogenic Liver Abscess in a Healthy Young Pilot: A Case Report

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Karger: Oncology

Most cited references 9

Pyogenic liver abscess: recent trends in etiology and mortality.

Treatment of pyogenic liver abscess: prospective randomized comparison of catheter drainage and needle aspiration.

Modern management of pyogenic hepatic abscess: a case series and review of the literature

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