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Xie Y, Guo LY, Liu B, Hu HL, Hu B, Chen TM, Qian SY, Hei MY, Liu G. Pyogenic liver abscess in pediatric populations in beijing (2008-2023). BMC Infect Dis 2024; 24:745. [PMID: 39075343 PMCID: PMC11285452 DOI: 10.1186/s12879-024-09634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/19/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Data on pyogenic liver abscess (PLA) of children in China have been limited. We aimed to summarize the clinical feather, microbiological characteristics, management, and outcome of PLA in children. METHOD We retrospectively reviewed PLA cases from January 2008 to June 2023 at Beijing Children's Hospital. Clinical characteristics, pathogens and management were analyzed. RESULTS We diagnosed 57 PLA patients in our center. The median onset age was 4.5 years and the male-to-female ratio was 1.6:1. The median diagnostic time was nine days and the median length of stay was 22 days. Twenty-eight patients (49.1%) had predisposing factors, around 71.4% of the patients had malignant hematology and primary immunodeficiency disease. Patients with underlying factors were more likely to have extrahepatic organ involvement (p = 0.024), anemia (p < 0.001), single abscess (p = 0.042), unilateral involvement (p = 0.039), and small size of the abscess (p = 0.008). Twenty-four patients (42.1%) had extrahepatic organ involvement. Pathogens were identified in 17 patients (29.8%), the most common pathogens were Klebsiella pneumoniae and Staphylococcus aureus. The positive rate of metagenomic next-generation sequencing (mNGS) was 87.5% (7/8). On multivariable analysis, the extrahepatic organ involved (p = 0.029) and hepatomegaly (p = 0.025) were two independent factors associated with poor outcomes. CONCLUSIONS PLA is usually seen in children with predisposing factors. Malignant hematology and primary immunodeficiency disease were the most common underlying diseases. Extrahepatic organ involvement and hepatomegaly are associated with poor prognosis. Increased use of mNGS could be beneficial for identifying pathogens.
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Affiliation(s)
- Yue Xie
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Bing Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Bing Hu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Tian-Ming Chen
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Su-Yun Qian
- Pediatric Intensive Care Unit, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ming-Yan Hei
- Neonatal Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Gang Liu
- Key Laboratory of Major Diseases in Children, Ministry of Education, Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
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Biswas S, Wahiduzzaman Mazumder M, Gupta U, Talukder P, Faruk MO. A Case Report on Fever of Unknown Origin in a 10-Year-Old: Tubercular Liver Abscess. Cureus 2024; 16:e56319. [PMID: 38629022 PMCID: PMC11020693 DOI: 10.7759/cureus.56319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2024] [Indexed: 04/19/2024] Open
Abstract
The liver, which presents as a focal point for tuberculosis in pediatric cases, is rarely encountered, and reported instances are scarce. This atypical manifestation underscores the management of tuberculosis affecting this particular organ in the context of pediatric patients. The treatment of solitary tubercular liver abscesses in children necessitates a collaborative approach, engaging pediatricians, infectious disease specialists, and interventional radiologists. It also needs awareness among physicians to explore and treat early and to complete further assessments for a better outcome. In our instance, investigating the cause of fever led us to diagnose a tubercular liver abscess in a previously healthy 10-year-old male. The substantiation of this diagnosis was accomplished through a meticulous liver biopsy, wherein immunohistochemistry was employed to detect tubercular pathogens. Following the confirmation of the diagnosis, the initiation of a targeted therapeutic regimen resulted in the subsequent resolution of the fever.
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Affiliation(s)
- Sumita Biswas
- Pediatrics, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | | | - Uma Gupta
- Internal Medicine, Interfaith Medical Center, New York, USA
| | - Purna Talukder
- Pediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
| | - Md Omar Faruk
- Pediatric Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, BGD
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Ogasawara K, Ono M, Tamanuki K, Wakatsuki R, Inoue K, Tateishi Y, Oda R, Shirane S, Funakoshi H, Kanegane H, Hatai Y. Respiratory Symptoms are the First Presentation of Liver Abscess. Pediatr Infect Dis J 2024; 43:e71-e73. [PMID: 37922482 DOI: 10.1097/inf.0000000000004160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
- Keisuke Ogasawara
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Makoto Ono
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Keita Tamanuki
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Ryosuke Wakatsuki
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Kento Inoue
- Department of Pediatrics and Developmental Biology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Tateishi
- Department of Infectious Diseases, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Rentaro Oda
- Department of Infectious Diseases, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Shogo Shirane
- Department of Interventional Radiology, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hiraku Funakoshi
- Department of Interventional Radiology, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
| | - Hirokazu Kanegane
- Department of Child Health and Development, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiho Hatai
- Department of Pediatrics, Tokyo Bay Urayasu-Ichikawa Medical Center, Chiba, Japan
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4
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Azevedo AC, Miranda S, Silva C, Martins S, Martinho I, Martins F. Fever and Abdominal Pain in a 13-Year-Old Boy. Clin Pediatr (Phila) 2023; 62:1118-1120. [PMID: 36707924 DOI: 10.1177/00099228221150696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- André Costa Azevedo
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
| | - Sofia Miranda
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
| | - Cátia Silva
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
| | - Sandrina Martins
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
| | - Isabel Martinho
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
| | - Francisca Martins
- Pediatrics Department, Unidade Local de Saúde do Alto Minho, Viana do Castelo Portugal
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Lao J, Song XP, Wang HS, Jiang RS, Luo Y, Sun J, Li ZH, Li C, Deng JK, Wang B, Ma XP, Wang JY. Severe congenital neutropenia and liver abscess: Surgical treatment breaks the vicious cycle. Heliyon 2023; 9:e19880. [PMID: 37810153 PMCID: PMC10559282 DOI: 10.1016/j.heliyon.2023.e19880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 10/10/2023] Open
Abstract
Here, we present a case with genetically confirmed SCN. The main symptom of the child was recurring fever. The combination of antibiotics combined with G-CSF injection was proved to be insufficient, and the patient developed "solid" liver abscess. After undergoing surgical anatomical hepatic lobectomy, the child's infection symptoms showed improvement. The postoperative culture of the purulent material from the liver infection lesion revealed an infection with Staphylococcus aureus. Our case raises the possibility of pathogen sources and routes of infection, clinical characteristics, and effective treatment for SCN patients with concomitant liver abscess.
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Affiliation(s)
- Jing Lao
- Shenzhen Children's Hospital of China Medical University, Shenzhen 518026, Guangdong Province, China
| | - Xin-Ping Song
- Shenzhen Children's Hospital of China Medical University, Shenzhen 518026, Guangdong Province, China
| | - Huan-Sheng Wang
- Shenzhen Children's Hospital of China Medical University, Shenzhen 518026, Guangdong Province, China
| | - Ren-Sen Jiang
- Shenzhen Children's Hospital of Shantou University, Shenzhen 518026, Guangdong Province, China
| | - Yu Luo
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Jun Sun
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Zhi-Han Li
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Chi Li
- Department of Infection, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Ji-Kui Deng
- Department of Infection, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Bin Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Xiao-Peng Ma
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
| | - Jian-Yao Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, 518026, Guangdong Province, China
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Anand M, Sahi PK, Mandal A. Pediatric Liver Abscess: Outcomes of Protocol-based Management and Predictors of Poor Outcome. Pediatr Infect Dis J 2023:00006454-990000000-00403. [PMID: 37053587 DOI: 10.1097/inf.0000000000003923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
BACKGROUND Liver abscess (LA) is an important cause of morbidity in children, especially in tropical countries. There is a paucity of data in pediatric LA with no standard guidelines regarding the best modality of treatment and drainage. With a large influx of patients at our center and protocol-based management; we aimed to study clinic-radiologic profile, risk factors, complications and outcomes of children with liver abscess and assessed possible predictors for poor outcomes. MATERIALS AND METHODS This retrospective observational study was conducted from January 2019 to September 2019 at a tertiary care hospital in India. Records of all children (<12 years of age) with ultrasonographically diagnosed liver abscess were accessed for clinic-radiological and demographic profile, laboratory investigations, treatment, complications and outcomes. Patients were categorized into favorable or unfavorable groups based on predefined criteria and were compared for possible predictors of poor outcomes. Outcomes for the protocol-based management were analyzed. RESULTS There were 120 cases of pediatric liver abscess with a median age of 5 years at presentation. The commonest clinical features were fever (100%) and pain in the abdomen (89.16%). The majority of liver abscesses were solitary (78.4%) and in the right lobe (73.3%). Malnutrition was present in 27.5%, overcrowding for 76.5% of patients and worm infestation in 2.5% of patients. Age-related leukocytosis (P = 0.004), neutrophilia (P = 0.013), elevated Aspartate transaminase (P = 0.008), elevated alanine transaminase (P = 0.007) and hypoalbuminemia (P = 0.014) were significantly more in the unfavorable group. Overall, 29.2% of patients underwent conservative management with antibiotics alone, 25.0% underwent percutaneous needle aspiration (PNA), 49.1% underwent ultrasound-guided percutaneous drain (PCD) insertion and open surgical drainage (OSD) was needed in a single patient. The success rate was 100% for conservative management, 76.6% for PNA, 94.7% for PCD and 100% for OSD with an overall mortality of 2.5%. CONCLUSIONS Age-related leukocytosis, neutrophilia, elevated aspartate transaminase or alanine transaminase and hypoalbuminemia at presentation are predictors of poor outcomes in pediatric liver abscess. Protocol-based management leads to the appropriate use of PNA and PCD while decreasing mortality and morbidity related to either.
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Affiliation(s)
- Mugdha Anand
- From the Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi
| | - Puneet Kaur Sahi
- Department of Pediatrics, Maulana Azad Medical College, New Delhi, India; and
| | - Anirban Mandal
- Department of Pediatrics, Sitaram Bhartia Institute of Research and Science, New Delhi, India
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7
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Chojniak R, Boaventura C. Invited Commentary: Diagnosis of Pediatric Liver Lesions. Radiographics 2022; 43:e220186. [DOI: 10.1148/rg.220186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rubens Chojniak
- From the Department of Imaging, A. C. Camargo Cancer Center, Professor Antonio Prudente 211, São Paulo, SP 01509-010, Brazil
| | - Camila Boaventura
- From the Department of Imaging, A. C. Camargo Cancer Center, Professor Antonio Prudente 211, São Paulo, SP 01509-010, Brazil
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8
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Abstract
Background and study aims: Liver abscesses are rare in the Western pediatric population and data on predisposing factors and etiology are scarce. We aimed to describe predisposing factors, microbiological characteristics, and treatment.
Patients and methods: Retrospective analysis of children admitted to two tertiary care hospitals in Belgium from 1 January 1996 to 31 December 2019. We analyzed clinical features, predisposing factors, imaging characteristics, microbiological data, treatment, and outcome in children with a liver abscess and compared these data with the literature.
Results: We collected 24 cases with a male to female ratio of 1.4 and a median age of 3.2 years at time of diagnosis. Survival was 95.8%. Invasive culture specimens were obtained in 83.3% and showed growth of bacteria in 55%. Parenteral antibiotics were administered before invasive culture sampling in 80%. Liver abscesses were cryptogenic in four (16.7%) patients. Hepatobiliary disease was the most prevalent predisposing factor (n = 6; 25%), followed by recent antineoplastic therapy for malignancies (n = 5; 20.8%), intra-abdominal surgical pathology (n = 4; 16.7%) and umbilical venous catheters (n = 2; 8.3%). In two patients there was a parasitic origin (n = 2; 8.3%) and in one it was caused by Bartonellosis. There was no diagnosis of chronic granulomatous disease (CGD) in our cohort.
Conclusions: Pediatric liver abscesses have a favorable outcome in the developed world. Whenever feasible, invasive abscess culture specimens should be obtained. In patients presenting with a cryptogenic liver abscess or atypical disease course, immunological workup should be ensured.
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9
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Lajos L, Singh P, Holmen JE. Toddler With Fever and Limp. Pediatr Infect Dis J 2022; 41:603-605. [PMID: 38285980 DOI: 10.1097/inf.0000000000003275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lauren Lajos
- From the Department of Pediatrics, Division of Pediatric Hospital Medicine, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Prachi Singh
- Department of Pediatrics, Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Jenna Eve Holmen
- Department of Pediatrics, Division of Pediatric Infectious Diseases, UCSF Benioff Children's Hospital Oakland, Oakland, California
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Ieşanu MI, Cliveti R, Anghel M, Stoicescu MM, Boboc C, Ioan A, Galoş F. Parasite-Induced Th2 Polarization—An Unusual Cause of Paediatric Hepatic Abscess. Medicina (B Aires) 2021; 57:medicina57121322. [PMID: 34946267 PMCID: PMC8705542 DOI: 10.3390/medicina57121322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Liver abscess (LA) is a serious infectious disease, but is relatively rare in the paediatric population, especially in developed countries. Mostly, hepatic abscesses are pyogenic, caused by Staphylococcus aureus, while in extremely rare cases can be caused by parasites, such as Ascaris lumbricoides. Antimicrobial therapy and percutaneous drainage are the treatments of choice, lowering the mortality caused by this infection. We report a case of a 3-year-old girl admitted to the hospital for abdominal pain and a low-grade fever, with abdominal ultrasonography revealing a hepatic lesion. Initial laboratory tests showed moderate anaemia, thrombocytosis, eosinophilia, high inflammatory markers, and normal liver function. A computed tomography scan revealed two liver abscesses located subdiaphragmatically, and a high immunoglobulin E (IgE) value (22,300 U/mL). After excluding other possible etiologies, the patient was tested for parasitic infections. IgE for Ascaris lumbricoides came slightly higher. In addition to empirical antibiotic treatment, the patient received albendazole and made an uneventful recovery, with the full remission of the abscesses and without the need for drainage. In certain cases, parasites such as Ascaris lumbricoides are capable of inducing a T helper 2 (Th2) dominated immune response, predisposing the host to eosinophilia, hyperIgE, and increased susceptibility to bacterial infections. Early diagnosis and treatment in these cases may lead to less invasive therapy options in order to obtain a full recovery. To the best of our knowledge, this is the only reported case in the literature of a paediatric patient with parasite-induced liver abscesses, with extremely high IgE values, minimal symptomatology, that made a fast, full recovery without the need of drainage.
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Affiliation(s)
- Mara-Ioana Ieşanu
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
- Correspondence:
| | - Ramona Cliveti
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
| | - Mălina Anghel
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
| | - Mihai-Mirel Stoicescu
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Cătălin Boboc
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
| | - Andreea Ioan
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
| | - Felicia Galoş
- Marie Curie Emergency Children’s Hospital, 041451 Bucharest, Romania; (R.C.); (M.A.); (M.-M.S.); (C.B.); (A.I.); (F.G.)
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
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Aneja A, Meena S, Venkatesh V, Lal SB. Pulmonary thromboembolism: A rare complication of amoebic liver abscess in a child. JGH OPEN 2021; 5:169-171. [PMID: 33490633 PMCID: PMC7812450 DOI: 10.1002/jgh3.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/25/2022]
Abstract
Amoebic liver abscess is common in children in developing countries due to lack of hygiene and sanitary conditions. Inferior vena cava thrombosis is a rare complication of this disease, with only a few cases reported in the literature, where this thrombus led to pulmonary thromboembolism. We report the case of a 7‐year‐old child with amoebic liver abscess who developed pulmonary thromboembolism and was promptly diagnosed and managed.
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Affiliation(s)
- Aradhana Aneja
- Division Of Paediatric GastroenterologyPost Graduate Institute Of Medical Education & ResearchChandigarhIndia
| | - Shamsunder Meena
- Division Of Paediatric GastroenterologyPost Graduate Institute Of Medical Education & ResearchChandigarhIndia
| | - Vybhav Venkatesh
- Division Of Paediatric GastroenterologyPost Graduate Institute Of Medical Education & ResearchChandigarhIndia
| | - Sadhna B Lal
- Division Of Paediatric GastroenterologyPost Graduate Institute Of Medical Education & ResearchChandigarhIndia
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