Multiple hepatosplenic tuberculous abscesses in an eight-year-old boy

Tuberculous splenic abscess in a neonate with thrombocytopenia

We present a case of a premature neonate who presented with anemia and persistent thrombocytopenia. The patient was ultimately diagnosed with disseminated tuberculosis. Initial sonographic evaluation of the abdomen revealed a heterogeneous but predominantly hypoechoic spleen; there was subsequent evolution of a splenic abscess. The patient was treated medically with anti-tubercular drugs. Follow-up post-treatment sonograms of the spleen showed diminution of the abscess and the evolution of multiple calcifications compatible with calcified granulomas. This case is an unusual presentation of tuberculosis in an infant with splenic abscess associated with thrombocytopenia and anemia.

[Hepatic abscesses in childhood: retrospective study about 33 cases observed in New-Caledonia between 1985 and 2003]

Hepatic abscesses in childhood are rarely observed in Europe. The aim of this word was to study how to diagnose and how to treat an hepatic abscess.

METHODS

Between 1985 and 2003, we recensed retrospectively 33 cases of hepatic abscesses hospitalised in the paediatric unit of Noumea.

RESULTS

Children were mainly melanesians (79%), 7 years old on average, having abdominal pains, a clinical and biological infectious syndrome, and abscesses images on ultrasonography or computed tomography. The identified micro-organisms included Entamoeba histolytica in 30% (10 cases); Staphylococcus aureus in 15% (five cases), Staphylococcus coagulase negative in 6% (two cases), Streptococcus D in 3% (one case); Bartonella henselae in 9% (three cases); ascaris in 6% (two cases); Mycobacterium tuberculosis in 6% (two cases). In eight cases no bacteria was identified (24%) but the good evolution after antibiotics and the negative amoebic serology looked like pyogenic abscesses. Two abscesses were aspirated, two were drained, one child had a surgical intervention. There was no death. Following a mean duration of 1 month for antibiotics treatment, outcome was always favourable.

CONCLUSION

Diagnosis of hepatic abscess can be difficult. Ultrasonography shows the abscess but not the causal agent. The amoebic serology is sensible, consequently, its negativity leads to evoke a pyogenic agent. Early antibiotic treatment against pyogenic, anaerobic bacteria, and Entamoeba histolytica is required. Hepatic abscesses in ascaridiosis, tuberculosis and cat-scratch disease are less frequently encountered. If diagnosis remains doubtful or clinical evolution worsens, or if abscess volume increases, a percutaneous aspiration or drainage is needed.