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Chandelia S. Pyogenic liver abscess presenting as fatal fulminant acute liver failure - a case report. Trop Doct 2024:494755241247086. [PMID: 38634122 DOI: 10.1177/00494755241247086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Liver abscess causing and presenting as acute liver failure is rare; it does not result in hepatitis as it causes focal hepatic necrosis. With drainage of pus, recovery is the rule. However, a child having multiple abscesses may present with acute fulminant liver failure.
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Affiliation(s)
- Sudha Chandelia
- Professor, Division of Pediatric Critical Care, Department of Pediatrics, ABVIMS and Associated Dr R.M.L Hospital, New Delhi, India
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2
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Suzuki N, Matsuoka A, Horiuchi M, Sasaki A, Motomura Y. Rapid tumor progression complicated with liver abscess in a patient with gastric cancer receiving nivolumab therapy. Int Cancer Conf J 2024; 13:119-123. [PMID: 38524660 PMCID: PMC10957815 DOI: 10.1007/s13691-023-00647-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 12/13/2023] [Indexed: 03/26/2024] Open
Abstract
Immune checkpoint inhibitors have been approved for treating various cancer types. However, several studies reported rapid tumor progression, a condition known as hyperprogressive disease, after treatment with immune checkpoint inhibitors. We present the case of a 73-year-old man diagnosed with recurrent gastric cancer with liver and lymph node metastases detected in the presence of obstructive jaundice. Concomitant administration of nivolumab with cytotoxic chemotherapy as first-line chemotherapy effectively controlled the tumor. Nevertheless, once cytotoxic chemotherapy was discontinued and nivolumab monotherapy was initiated to treat liver abscess complications, the tumor rapidly progressed, ultimately leading to the patient's death. This is the first report on rapid tumor growth observed during subsequent treatment with nivolumab after initial antitumor effects were confirmed. This case report describes the possibility of rapid tumor growth in patients receiving immune checkpoint inhibitor therapy, including in cases where this therapy showed antitumor efficacy in the initial therapeutic evaluation. Therefore, patients receiving immune checkpoint inhibitor therapy need to be monitored.
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Affiliation(s)
- Natsumi Suzuki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
- Department of General Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
| | - Anna Matsuoka
- Department of General Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
| | - Masao Horiuchi
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
| | - Akinori Sasaki
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
- Department of Oncology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
| | - Yasuaki Motomura
- Department of Gastroenterology, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasu, Chiba 279-0001 Japan
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3
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Dumic I, Caetano EM, Domingues SM, Pantic I, Radovanovic M, Prada LR, Nordstrom CW, Antic M, Milovanovic T, Kotseva M, Singh A, Fnu S. Clinical characteristics, diagnosis, treatment, and outcome of patients with liver abscess due to Aspergillus spp: a systematic review of published cases. BMC Infect Dis 2024; 24:345. [PMID: 38519916 PMCID: PMC10960385 DOI: 10.1186/s12879-024-09226-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/14/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Aspergillus spp liver abscess is a relatively rare entity and thus far no systematic review has been performed examining patients' demographics, clinical manifestations, diagnosis, management, and outcome. METHODS We performed a systematic review of the literature using MEDLINE and LILACS databases. We searched for articles published in the period from January 1990 to December 24, 2022, to identify patients who developed liver abscesses due to Aspergillus spp. RESULTS Our search yielded 21 patients all of whom had invasive aspergillosis confirmed on liver biopsy. Of these patients 81% were adults, and 60% were males. The majority (86%) of patients were immunocompromised and 95% had symptomatic disease at the time of diagnosis. The most common symptoms were fever (79%), abdominal pain (47%), and constitutional symptoms (weight loss, chills, night sweats, fatigue) (38%). Liver enzymes were elevated in 50%, serum galactomannan was positive in 57%, and fungal blood cultures were positive in only 11%. Co-infection with other pathogens preceded development of apsergillosis in one-third of patients, and the majority of the abscesses (43%) were cryptogenic. In the remaining patients with known source, 28% of patients developed liver abscess through dissemination from the lungs, 19% through the portal vein system, and in 10% liver abscess developed through contiguous spread. The most common imaging modality was abdominal computerized tomography done in 86% of patients. Solitary abscess was present in 52% of patients while 48% had multiple abscesses. Inadequate initial empiric therapy was prescribed in 60% of patients and in 44% of patients definite treatment included combination therapy with two or more antifungal agents. Percutaneous drainage of the abscesses was done in 40% of patients, while 20% required liver resection for the treatment of the abscess. Overall mortality was very high at 38%. CONCLUSION Further studies are urgently needed for a better understanding of pathophysiology of liver aspergillosis and for developement of newer blood markers in order to expedite diagnosis and decrease mortality.
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Affiliation(s)
- Igor Dumic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.
| | | | | | - Ivana Pantic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milan Radovanovic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Libardo Rueda Prada
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Jacksonville, Florida, USA
| | - Charles W Nordstrom
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Marina Antic
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA
| | - Tamara Milovanovic
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Magdalena Kotseva
- Internal Medicine Residency Program, Franciscan Health, Olympia Fields, IL, USA
| | - Amteshwar Singh
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shweta Fnu
- Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Infectious Diseases, Mayo Clinic Health System, Eau Claire, WI, USA
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Wang YW, Mo SY, Li YZ. [A case of hepatocellular carcinoma of fibrolamellar type misdiagnosed as a liver abscess]. Zhonghua Gan Zang Bing Za Zhi 2024; 32:242-244. [PMID: 38584106 DOI: 10.3760/cma.j.cn501113-20230815-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Affiliation(s)
- Y W Wang
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
| | - S Y Mo
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
| | - Y Z Li
- Department of Gastroenterology, Liuzhou People's Hospital, Liuzhou 545000, China
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Alasso AAO, Ibrahim IG, Ali IA, Ahmed MR. A case report and treatment considerations for pyogenic liver abscess with biliary fistula. Int J Surg Case Rep 2024; 116:109343. [PMID: 38350374 PMCID: PMC10943647 DOI: 10.1016/j.ijscr.2024.109343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Pyogenic liver abscess (PLA) is a potentially life-threatening condition characterized by the formation of space-occupying lesions within the liver parenchyma. Despite advancements in diagnostic imaging and antibiotic therapies, complications such as biliary fistula formation can arise, posing challenges in management. CASE PRESENTATION This case study presents a 23-year-old male patient with PLA complicated by a biliary fistula. Diagnostic imaging via CT scan and MRI confirmed a liver abscess and biliary dilation. The patient underwent a second drainage for ascitic fluid following the initial percutaneous liver catheter drainage. CLINICAL DISCUSSION The patient responded positively to the treatment, with reduced abscess size and fistula resolution. While endoscopic interventions offer promising results, their limited availability necessitates alternative treatment strategies, such as percutaneous drainage and appropriate antibiotics. CONCLUSION This case emphasises the importance of individualized management approaches for PLA complicated by biliary fistulas. Despite the challenges, successful outcomes can be achieved through careful management and appropriate treatment strategies.
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Affiliation(s)
| | - Ismail Gedi Ibrahim
- Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Somalia
| | | | - Mohamed Rage Ahmed
- Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Somalia
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De Francesco MA, Villanacci V, Pasini M, Ciccarone A, Bertoni F, Gottardi F, Tomasoni LR. Amoebic colitis and liver abscess: A rare case of autochthonous invasive infection due to Entamoeba histolytica. J Infect Public Health 2024; 17:464-466. [PMID: 38262084 DOI: 10.1016/j.jiph.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/25/2024] Open
Abstract
We report an unusual and confirmed case of invasive amebiasis in a non-endemic area where the source of infection remains unknown. During her admission, the patient developed amebic colitis and extraintestinal liver abscess with a favorable outcome following the antiparasitic therapy.
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Affiliation(s)
- Maria Antonia De Francesco
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy.
| | | | - Mario Pasini
- Department of Surgery ASST-Spedali Civili Brescia, Italy
| | - Andrea Ciccarone
- Department of Infectious and Tropical Diseases ASST-Spedali Civili Brescia, Italy
| | - Francesca Bertoni
- Department of Infectious and Tropical Diseases ASST-Spedali Civili Brescia, Italy
| | - Federica Gottardi
- Department of Infectious and Tropical Diseases ASST-Spedali Civili Brescia, Italy
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Portunato F, Bartalucci C, Vena A, Giacobbe DR, Porcile E, Montanelli P, Piol N, Centanaro M, Andorno E, Bassetti M. Amoebic Liver Abscess: Potential Application of New Diagnostic Techniques for an Old Pathogen. Infect Dis Ther 2024; 13:625-632. [PMID: 38459236 DOI: 10.1007/s40121-024-00934-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 01/26/2024] [Indexed: 03/10/2024] Open
Abstract
Amoebic liver abscess is a severe and potentially life-threatening infection requiring prompt diagnosis and early targeted treatment. Diagnosis is challenging because conventional diagnostic methods such as light microscopy and serology are often unreliable. Molecular techniques have emerged as an additional diagnostic tool, suddenly becoming the new diagnostic reference standard. More recently, commercial multiplex PCR panels, including FilmArray, have been introduced, which permit the simultaneous detection of several enteric pathogens including Entamoeba histolytica in stool samples. We report a case of an amoebic liver abscess promptly diagnosed by FilmArray gastrointestinal panel performed on liver drainage fluid.
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Affiliation(s)
- Federica Portunato
- Infectious Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
| | - Claudia Bartalucci
- Infectious Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy.
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy.
| | - Antonio Vena
- Infectious Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
| | - Elisa Porcile
- Anesthesiology and Intensive Care Unit, IRCCS Ospedale Policlinico San Martino-IST National Institute for Cancer Research, Genoa, Italy
| | - Paolo Montanelli
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nataniele Piol
- Department of Pathology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Centanaro
- Anesthesiology and Intensive Care Unit, IRCCS Ospedale Policlinico San Martino-IST National Institute for Cancer Research, Genoa, Italy
| | - Enzo Andorno
- Department of Hepatobiliarypancreatic Surgery and Liver Transplantation Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Matteo Bassetti
- Infectious Disease Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Largo Rosanna Benzi, 10, 16132, Genoa, GE, Italy
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genova, Genoa, Italy
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8
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Bian L, Yang J, Song Z. Risk factors of liver abscess and biloma formation after drug-eluting bead transarterial chemoembolization for unresectable intrahepatic cholangiocarcinoma. Arab J Gastroenterol 2024:S1687-1979(24)00012-1. [PMID: 38388217 DOI: 10.1016/j.ajg.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 01/04/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND STUDY AIMS Drug-eluting bead transarterial chemoembolization (DEB-TACE) causes serious complications, including liver abscess and biloma formation. This study aimed to investigate the frequency and risk factors of liver abscess and biloma formation after dug-eluting bead transarterial chemoembolization for unresectable intrahepatic cholangiocarcinoma (ICC). PATIENTS AND METHODS 152 unresectable ICC patients received 241 DEB-TACE procedures from February 2018 to November 2022 were studied retrospectively. Patients were evaluated for the presence of liver abscess and biloma formation after DEB-TACE. The medical records, including baseline demographic data, preoperative imaging data, DEB-TACE details, and postoperative management, were reviewed to search for risk factors of liver abscess and biloma formation. RESULTS Liver abscesses developed in 11 cases, with an incidence rate of 7.2 % (11/152) per patient and 4.6 % (11/241) per procedure. In the 11 patients with abscesses, the incidence of biloma formation was 36.4 % (n = 4). The binary logistic regression analysis showed that diabetes mellitus (OR 7.967, 95 % CI 1.491-42.571, p = 0.015), bilioenterostomy or biliary stent implantation (OR 18.716, 95 % CI 1.006-348.049, p = 0.049) and grade 1 arterial occlusion (OR 9.712, 95 % CI 1.054-89.484, p = 0.045) were independent risk factors for liver abscess and biloma formation. CONCLUSION Liver abscesses and biloma formation induced by DEB-TACE are associated with various factors. Diabetes mellitus, bilioenterostomy or biliary stent implantation, and grade 1 artery occlusion were all associated with liver abscess and biloma formation after DEB-TACE for unresectable ICC. In patients with these risk factors, the DEB-TACE procedure should be finely designed and manipulated with more caution.
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Affiliation(s)
- Longhao Bian
- Department of Interventional Treatment, Third Hospital of Qinhuangdao, No.222 Jianguo Road, Qinhuangdao, Hebei Province, China
| | - Jianjun Yang
- Department of Interventional Treatment, Third Hospital of Qinhuangdao, No.222 Jianguo Road, Qinhuangdao, Hebei Province, China
| | - Zhaomin Song
- Department of Interventional Treatment, Third Hospital of Qinhuangdao, No.222 Jianguo Road, Qinhuangdao, Hebei Province, China.
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Chung LYE, Ho YY, Juan SJ. A pickup for a case of hiccups: point-of-care ultrasonography detects a liver abscess in a 74-year-old gentleman. CAN J EMERG MED 2024; 26:128-129. [PMID: 38097909 DOI: 10.1007/s43678-023-00623-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/14/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Lynette Yan Ee Chung
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore, Singapore.
| | - Yun Ying Ho
- General Medicine Department, Sengkang General Hospital, Singapore, Singapore
| | - Sze Joo Juan
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore, Singapore
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10
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Marak JR, Raj G, Narayan S, Gara H, Das P. Liver abscess with extension into the Inferior Vena Cava: Case series of a rare complication. Radiol Case Rep 2024; 19:594-599. [PMID: 38111551 PMCID: PMC10726337 DOI: 10.1016/j.radcr.2023.10.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 10/21/2023] [Accepted: 10/26/2023] [Indexed: 12/20/2023] Open
Abstract
Liver abscess is a common disease, however, it is a rare cause of venous thrombosis. The incidence of amoebic and pyogenic liver abscess in developing countries is high, however, the occurrence of inferior vena cava thrombosis secondary to liver abscess is a very rare and life-threatening complication. Computed tomography (CT) scan is an ideal investigation tool for diagnosing the various complications associated with liver abscess. Here we describe 3 cases of liver abscess in patients who developed a rare vascular complication of inferior vena cava. Liver abscesses should be considered as a rare cause of IVC thrombosis in the correct clinical context. All the patients were managed with ultrasound-guided pigtail insertion and antimicrobial agents.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Gaurav Raj
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Shamrendra Narayan
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Harsha Gara
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Priya Das
- Department of Radiodiagnosis, Dr RMLIMS, Lucknow, Uttar Pradesh, 226010, India
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Kawase K, Okamoto K, Harada S, Nomura Y, Shimada S, Komae H, Kuroda R, Ideyama M, Soma K, Mizoguchi M, Higurashi Y, Ukai K, Adachi-Katayama M, Miwa T, Wakimoto Y, Oyabu T, Jubishi D, Hashimoto H, Okugawa S, Ono M, Doi K, Ushiku T, Tsutsumi T. A case of hypervirulent K1-ST23 Klebsiella pneumoniae endocarditis and papillary muscle rupture secondary to multiple site abscesses. J Infect Chemother 2024; 30:154-158. [PMID: 37776972 DOI: 10.1016/j.jiac.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 10/02/2023]
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP) causes multisite infections and abscesses. However, endocarditis is a rare presentation of hvKP infection. Herein, we report a case of K. pneumoniae native valve infective endocarditis secondary to community-acquired liver and prostate abscesses. The patient developed papillary muscle rupture, leading to mitral regurgitation, and underwent emergent mitral valve replacement. The diagnosis of endocarditis was confirmed microbiologically and histologically. The causative strain belonged to the hypermucoid K1 capsular genotype and possessed the rmpA gene. The genome sequence was deposited in GenBank under the accession number JAQZBZ000000000.
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Affiliation(s)
- Kyotaro Kawase
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan.
| | - Sohei Harada
- Department of Infection Control and Prevention, University of Tokyo Hospital, Tokyo, Japan
| | - Yusuke Nomura
- Department of Infection Control and Prevention, University of Tokyo Hospital, Tokyo, Japan
| | - Shogo Shimada
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Hyoe Komae
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Ryohei Kuroda
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Mana Ideyama
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Katsura Soma
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Miyuki Mizoguchi
- Department of Infection Control and Prevention, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshimi Higurashi
- Department of Infection Control and Prevention, University of Tokyo Hospital, Tokyo, Japan
| | - Kohei Ukai
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Maho Adachi-Katayama
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Toshiki Miwa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuji Wakimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Tatsunori Oyabu
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Daisuke Jubishi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Hideki Hashimoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Minoru Ono
- Department of Cardiac Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Kent Doi
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Tetsuo Ushiku
- Department of Pathology, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeya Tsutsumi
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan; Department of Infection Control and Prevention, University of Tokyo Hospital, Tokyo, Japan
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Rajesh R, Gupta M, Kaur N, Lehl SS, Tahlan A, Kaur D. Prevalence of vascular thrombosis in patients with liver abscess. Trop Doct 2024; 54:23-26. [PMID: 37774768 DOI: 10.1177/00494755231204920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Thrombotic complications in liver abscess are less commonly identified in the literature. In this prospective observational study, vascular thrombosis was detected in 21.9% cases. However, there was no significant difference in outcome with or without vascular thrombosis, properly treated.
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Affiliation(s)
- Rayidi Rajesh
- Postgraduate Student, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Professor, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Narinder Kaur
- Professor, Department of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Sarabmeet Singh Lehl
- Professor, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Anita Tahlan
- Professor, Department of Pathology, Government Medical College and Hospital, Chandigarh, India
| | - Daljinderjit Kaur
- Postgraduate Resident, Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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13
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Salam R, Verma A, Noeske M, Alnimer L, Sieloff EM, Piper MS. Gastrointestinal Variant of Lemierre Syndrome due to Fusobacterium nucleatum: A Case Report. Case Rep Gastroenterol 2024; 18:144-152. [PMID: 38501151 PMCID: PMC10948173 DOI: 10.1159/000536619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with Streptococcus species and Escherichia coli as the predominant causal pathogens in Western countries. Fusobacterium species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. Case Presentation We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed Fusobacterium nucleatum etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. Conclusion Fusobacterium species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.
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Affiliation(s)
- Reshad Salam
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Abhiroop Verma
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Michael Noeske
- Division of Radiology, Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA
| | - Lynna Alnimer
- Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Eric M. Sieloff
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Marc S. Piper
- Division of Gastroenterology, Department of Internal Medicine, Ascension Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
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14
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Luo Y, Hu W, Wu L, Duan S, Zhong X. Klebsiella pneumoniae invasive syndrome with liver, lung, and brain abscesses complicated with pulmonary fungal infection: a case report and review of the literature. Int J Emerg Med 2023; 16:92. [PMID: 38129781 PMCID: PMC10734080 DOI: 10.1186/s12245-023-00574-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae invasion syndrome (KPIS) is a severe multi-site infection that is usually caused by hypervirulent Klebsiella pneumoniae. The bacteria are relatively common in Asian diabetics and can cause organ abscesses or sepsis. When patients develop intracranial infection, the prognosis is poor. After anti-infective treatment, the Klebsiella pneumoniae-induced liver and lung abscesses and pulmonary fungal infection were relieved, but the brain abscesses worsened. Such complex and severe infection cases are rarely reported. Early identification of intracranial infection, selection of antibiotics with high concentrations in cerebrospinal fluid, and active treatment of complications such as diabetes and fungal infection are of great significance for the prognosis of patients. CASE PRESENTATION A 71-year-old patient diagnosed with liver abscess in another hospital was transferred to our hospital due to a worsening condition. On day 1 (day of admission), the patient was given invasive mechanical ventilation, continuous renal replacement therapy combined with endotoxin adsorption, antimicrobial treatment with imipenem-cilastatin, and percutaneous catheter drainage for liver abscess. Metagenomic next-generation sequencing in bronchoalveolar lavage fluid indicated Klebsiella pneumoniae (K. pneumoniae), Candida albicans, and Aspergillus flavus complex, and no viruses were detected. Blood and pus cultures revealed K. pneumoniae that was sensitive to piperacillin/tazobactam. The anti-infection therapy was adjusted to piperacillin/tazobactam combined with voriconazole. On day 14, a head computed tomography (CT) scan showed no significant changes, and a chest CT scan showed absorption of multiple abscesses in both lungs. The patient was still unconscious. After the endotracheal tube was removed, cranial magnetic resonance imaging (MRI) showed multiple brain abscesses. Finally, his family gave up, and the patient was discharged and died in a local hospital. CONCLUSION In cases of K. pneumoniae infection, the possibility of intracranial, liver, lung, or other site infections should be considered, and physicians should be vigilant for the occurrence of KPIS. For patients suspected of developing an intracranial infection, cerebrospinal fluid should be tested and cultured as soon as possible, a head MRI should be performed, and antibiotics with high distribution in cerebrospinal fluid should be used early. When patients are complicated with diabetes, in addition to glycemic control, vigilance for concurrent fungal infections is also needed.
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Affiliation(s)
- Yunhao Luo
- Department of Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China
| | - Wen Hu
- Department of Critical Care Medicine, Chengdu Seventh People's Hospital, Chengdu, China
| | - Lingna Wu
- Department of Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China
| | - Shijie Duan
- Department of Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China
| | - Xingmei Zhong
- Department of Critical Care Medicine, Chengdu First People's Hospital, Chengdu, China.
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15
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Ryou SH, Shin HD, Kim SB. Hepatocellular carcinoma presenting as organized liver abscess: A case report. World J Clin Cases 2023; 11:8078-8083. [DOI: 10.12998/wjcc.v11.i33.8078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/02/2023] [Accepted: 11/17/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is difficult to treat and has a high mortality rate, emphasizing the importance of early diagnosis and treatment. If characteristic radiologic findings and underlying liver disease are present, a diagnosis can be made without a biopsy. However, when HCC is accompanied by a liver abscess, diagnosis might be delayed by atypical radiologic findings. This case report aims to assist in the diagnosis of HCC, which can manifest in various forms.
CASE SUMMARY A 75-year-old male presented to the Emergency Department with worsening fever and mental changes. He was diagnosed with liver cirrhosis six months earlier. Abdominal computed tomography (CT) raised our suspicion of an organized liver abscess. A follow-up CT scan after four weeks of antibiotic treatment showed a decrease in the liver lesion size. However, high fever recurred, and C-reactive protein increased to 14 mg/L. Aspiration of the liver lesion was performed, but no bacteria were identified. Blood culture revealed the presence of fungi. The patient received an additional four weeks of antibiotics and antifungal agents before being discharged. Approximately 10 mo later, a CT scan showed an increase in the lesion size, and biopsy was performed. The biopsy revealed an organized abscess with focal carcinomatous changes, for which surgery was performed. Postoperative histopathological examination revealed HCC, clear-cell variant. The nontumor liver tissue showed cirrhosis and an organized abscess.
CONCLUSION Even if a liver abscess is suspected in a patient with cirrhosis, the possibility of HCC should be considered.
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Affiliation(s)
- Sung Hyeok Ryou
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
| | - Hyun Deok Shin
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
| | - Suk Bae Kim
- Department of Internal Medicine, Dankook University College of Medicine, Cheonan 31116, Chungnam, South Korea
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16
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Cirimele V, D'Amone G, Vertulli D, Spagnolo G, Pileri M, Montanari E, Faiella E, Zobel BB. Liver abscess after endoscopic sleeve gastroplasty: A case report. Radiol Case Rep 2023; 18:4187-4190. [PMID: 37753500 PMCID: PMC10518679 DOI: 10.1016/j.radcr.2023.08.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/26/2023] [Indexed: 09/28/2023] Open
Abstract
Endoscopic sleeve gastroplasty is a minimally invasive procedure for the treatment of obesity. The procedure is generally safe and well-tolerated, but major adverse events occur in up to 3% of patients. Perigastric abscess is a potential complication caused by postprocedural gastric leak. To the best of our knowledge, no cases of hepatic abscess (HA) following endoscopic sleeve gastroplasty have been reported, while HA is a well-known complication of laparoscopic sleeve gastrectomy. We report the case of a patient who developed a liver abscess 2 weeks after endoscopic sleeve gastroplasty. The patient improved with administration of intravenous antibiotics and endoscopic drainage.
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Affiliation(s)
- Vincenzo Cirimele
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giulia D'Amone
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Daniele Vertulli
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Giuseppe Spagnolo
- Bariatric Surgery Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Matteo Pileri
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Edoardo Montanari
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Eliodoro Faiella
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
| | - Bruno Beomonte Zobel
- Diagnostic Imaging Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200-00128 Roma, Italy
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17
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Gottschling M, Lerzer C, Geismann F, Schmalenberger D, Blaas S, Simsek M, Malfertheiner M, Salzberger B, Hitzenbichler F, Hamer OW, Utpatel K, Neu R, Ried M, Mohr A. [Rare cause of necrotizing pneumonia : A case report]. Inn Med (Heidelb) 2023; 64:1119-1122. [PMID: 37296328 DOI: 10.1007/s00108-023-01540-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/12/2023]
Abstract
A 29-year-old Indian patient was admitted to the authors' pulmonary clinic with cough and fever. Community-acquired pneumonia was initially suspected. Various antibiotic therapies were administered, which did not lead to any clinical improvement. Despite detailed diagnostics, no pathogen was found. Computed tomography showed rapidly progressive pneumonia in the left upper lobe. Since the infection could not be managed conservatively, upper lobe resection was performed. Histologically, an amoebic abscess was found to be the cause of the infection. Since cerebral and hepatic abscesses were also found, hematogenous dissemination may be assumed.
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Affiliation(s)
- Malin Gottschling
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland.
| | - Christoph Lerzer
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
| | - Florian Geismann
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
| | - Daniel Schmalenberger
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
| | - Stefan Blaas
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
| | - Meral Simsek
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
| | | | - Bernd Salzberger
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Florian Hitzenbichler
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Okka W Hamer
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
- Abteilung für Radiologie, Klinik Donaustauf, Donaustauf, Deutschland
| | - Kirsten Utpatel
- Institut für Pathologie, Universität Regensburg, Regensburg, Deutschland
| | - Reiner Neu
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Michael Ried
- Abteilung für Thoraxchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Arno Mohr
- Zentrum für Pneumologie, Klinik Donaustauf, Ludwigstr. 68, 93093, Donaustauf, Deutschland
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18
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Salgado OJ, Pesantes-Barros KS, Rosales BC, Espinosa-Martin L. Pyelo-hepatic abscess caused by staghorn stone infection: a case report. J Med Case Rep 2023; 17:440. [PMID: 37867194 PMCID: PMC10591354 DOI: 10.1186/s13256-023-04173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare. CASE REPORT The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.
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Affiliation(s)
- Octavio J Salgado
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador.
- Department of Nephrology, University Hospital of Maracaibo, Maracaibo, 4001, Zulia, Venezuela.
| | - Katherine S Pesantes-Barros
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador
| | - Beatriz C Rosales
- Department of Nephrology, University Hospital of Maracaibo, Maracaibo, 4001, Zulia, Venezuela
| | - Lizette Espinosa-Martin
- School of Medicine, Universidad Católica de Cuenca, Av. Las Americas Y Humbolt, Cuenca, 010101, Azuay, Ecuador
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19
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Abdelmahmuod EA, Elayana M, Subahi E, Aker L, Alamin MA, Alfitori G. Tuberculous liver abscess as a unique cause of liver abscess: A case report and literature review. Heliyon 2023; 9:e20755. [PMID: 37860564 PMCID: PMC10582401 DOI: 10.1016/j.heliyon.2023.e20755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 10/21/2023] Open
Abstract
Introduction TLA is most commonly associated with an immunocompromised state, a focus of infection in the lungs or gastrointestinal system, or as part of congenital or miliary tuberculosis. Isolated TLA is rare, with only a few cases reported in the literature. Methods We describe a case of a 24-years-old healthy male with an isolated Tuberculous Liver abscess presented with prolonged fever, abdominal pain, and general malaise. He was successfully treated with a 6-month antituberculosis regimen and percutaneous abscess drainage. Discussion and conclusion The signs and symptoms of isolated TLA are nonspecific. The diagnosis requires a high index of suspicion, especially in endemic areas and in individuals with a known tuberculosis risk factor. A better outcome is linked to an early diagnosis and timely treatment with systemic Antituberculous medications. This case report highlights the importance of considering TLA (Tuberculous or Tubercular Liver Abscess) when diagnosing hepatic masses or abscesses as a possible cause of extrapulmonary tuberculosis (EPTB).
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Affiliation(s)
| | - Mahmoud Elayana
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Eihab Subahi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Loai Aker
- Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | | | - Gamal Alfitori
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Park Y, Han HS, Yoon YS, Cho JY, Lee B, Kang M, Kim J, Lee HW. Pyogenic liver abscess secondary to gastric perforation of an ingested toothpick: A case report. World J Clin Cases 2023; 11:5622-5627. [PMID: 37637697 PMCID: PMC10450364 DOI: 10.12998/wjcc.v11.i23.5622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/07/2023] [Accepted: 07/24/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Liver abscess due to foreign body-induced gastrointestinal tract perforation is a rare event that could be misdiagnosed due to low suspicion. Less than 100 cases have been reported to date. CASE SUMMARY We report a case of a 53-year old female patient with pyogenic liver abscess secondary to ingestion of a toothpick with penetration through the lesser curvature of the stomach. The patient presented with persistent epigastric pain. Abdominal computed tomography demonstrated the presence of a linear radiopaque object associated with abscess formation in the left liver lobe. Inflammatory changes in the lesser curvature of the stomach indicated gastric wall penetration by the object. As the abscess was refractory to antibiotic treatment, laparoscopic liver resection was performed to remove the foreign body and adjacent liver parenchyma. Following surgery, symptoms fully resolved without any sequelae. CONCLUSION This rare case demonstrates the importance of considering foreign body penetration as a cause of pyogenic liver abscess, particularly in abscesses of unknown origin that are resistant to antibiotic therapy. Clinical suspicion, early diagnosis, and prompt removal of the foreign body could lead to improved outcomes in these patients.
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Affiliation(s)
- Yeshong Park
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Boram Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - MeeYoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Jinju Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
| | - Hae Won Lee
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam-si 13620, South Korea
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22
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Zhang X, Jiyun Zhou, Yinhong Zhu, Ye X, Bo D, Tianjiao Tang, Huang X, Qu T. A case report of liver abscesses caused by Fusobacterium necrophorum in immunocompetent patient and review of the literature. Heliyon 2023; 9:e18535. [PMID: 37520974 PMCID: PMC10374925 DOI: 10.1016/j.heliyon.2023.e18535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 07/14/2023] [Accepted: 07/20/2023] [Indexed: 08/01/2023] Open
Abstract
Background Fusobacterium necrophorum is an anaerobic Gram-negative bacterium that can lead to opportunistic infections, including Lemierre's syndrome and less common presentations of metastatic diseases. However, liver abscesses infected by Fusobacterium necrophorum in clinical settings are rarely reported, particularly in people with normal immune function. Case presentation A 35-year-old Chinese man was admitted with hyperthermia and abdominal pain that had persisted for three days. The patient continued to have a fever with a maximum temperature of 39.8 °C during hospitalization. Computed Tomography revealed multiple low-density lesions in the liver, which were diagnosed as liver abscesses caused by Fusobacterium necrophorum infection through blood culture and anaerobic liver abscess fluid culture. After simple local percutaneous abscess drainage and effective anti-infective therapy, the patient achieved complete remission. Conclusions Results of our literature search query revealed rare reports of liver abscesses infected by Fusobacterium necrophorum. We recommend that Fusobacterium necrophorum infection be considered in diagnosis special situations of liver abscess.
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Affiliation(s)
- Xiaoqiang Zhang
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Jiyun Zhou
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Yinhong Zhu
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Xufang Ye
- Department of Laboratory Medicine, First People's Hospital of Linping District, Hangzhou, China
| | - Dehua Bo
- Department of Ultrasonography, First People's Hospital of Linping District, Hangzhou, China
| | - Tianjiao Tang
- Department of Infectious Disease, Liangzhu Hospital, Yuhang District, Hangzhou, China
| | - Xiaojing Huang
- Department of Infectious Disease, First People's Hospital of Linping District, Hangzhou, China
| | - Tingting Qu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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23
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Hu W, Lin X, Qian M, Du TM, Lan X. Treatment of Candida albicans liver abscess complicated with COVID-19 after liver metastasis ablation: A case report. World J Gastrointest Oncol 2023; 15:1311-1316. [PMID: 37546559 PMCID: PMC10401469 DOI: 10.4251/wjgo.v15.i7.1311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Liver interventional surgery is a relatively safe and minimally invasive surgery. However, for patients who have undergone Whipple surgery, the probability of developing a liver abscess after liver interventional surgery is very high. Fungal liver abscess has a high mortality rate, especially when complicated with malignant tumors, diabetes, coronavirus disease 2019 (COVID-19) and other complications. Fungal liver abscess is rare, and there are no guidelines or expert consensus on the course of antifungal therapy.
CASE SUMMARY A 54-year-old woman with pancreatic head cancer received albumin-bound paclitaxel in combination with gemcitabine chemotherapy after laparoscopic pancreaticoduodenectomy. Liver metastasis was found 1 mo after completion of 8 cycles of chemotherapy, followed by ablation of the liver metastasis. After half a month of liver metastasis ablation, the patient experienced fever after chemotherapy and was diagnosed with liver abscess complicated with COVID-19 by contrast-enhanced abdominal computed tomography and real-time polymerase chain reaction detection. The results of pus culture showed Candida albicans, which was sensitive to fluconazole. The patient underwent percutaneous catheter drainage, antifungal therapy with fluconazole, and antiviral therapy with azvudine. During antifungal therapy, the patient showed a significant increase in liver enzyme levels and was discharged after liver protection therapy. Oral fluconazole was continued for 1 wk outside the hospital, and fluconazole was used for a total of 5 wk. The patient recovered well and received 4 cycles of fluorouracil, leucovorin, oxaliplatin, and irinotecan after 2 mo of antifungal therapy.
CONCLUSION Effective treatment of Candida albicans liver abscess requires early detection, percutaneous catheter drainage, and 5 wk of antifungal therapy. Meanwhile, complications such as COVID-19 should be actively managed and nutritional support should be provided.
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Affiliation(s)
- Wen Hu
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi Lin
- Department of Oncology, Yanting County People’s Hospital, Mianyang 621600, Sichuan Province, China
| | - Meng Qian
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Tao-Ming Du
- Department of Radiology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
| | - Xi Lan
- Department of Oncology, Chengdu Seventh People’s Hospital, Chengdu 610000, Sichuan Province, China
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24
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Pandey A, Rajeshwari K, Kumar D, Gupta G. Assessment of risk factors in pyogenic liver abscesses in children. Afr J Paediatr Surg 2023; 20:218-223. [PMID: 37470559 PMCID: PMC10450120 DOI: 10.4103/ajps.ajps_15_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/22/2022] [Accepted: 06/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Pyogenic liver abscess (LA) is a significant contributor to morbidity and mortality in developing countries like India. The risk factors predisposing to the LA specifically in children are not known. Studies done in the past largely remain inconclusive and have identified only probable causes. The cause of LA in children with no coexisting illness remains unknown. Methodology This prospective observational study was conducted at a tertiary teaching hospital located in New Delhi, India. All children between 2 months and 12 years of age with sonographically confirmed LA presenting to the hospital were included and managed with appropriate intravenous antibiotics and relevant investigations. Results A total of 52 children were included. The mean age was 6 years and 4 months, and the male: female ratio was 1.4:1. Around 50% of the patients were malnourished. Fever, abdominal pain and loss of appetite were the most common symptoms. Nine patients (17%) were managed conservatively, 13 (25%) needed percutaneous needle aspiration and 30 (57.69%) required drainage using a pigtail catheter. Poor socioeconomic status and anaemia were found to be the most commonly associated risk factors. Selective immunoglobulin A (IgA) deficiency was the most common primary immunodeficiency disorder followed by T-cell defect. On multivariate analysis, it was seen that in those with clinical icterus, gamma-glutamyl transferases >350 IU/m, and those with impending rupture, the time to defervescence was significantly different (P = 0.05). Conclusion Poor socioeconomic status causing malnutrition emerged as a significant risk factor for LA in children. Selective IgA deficiency was the most common immunodeficiency seen in a few children. Adopting a conservative approach like aspiration and percutaneous drainage led to lower mortality and good recovery rates.
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Affiliation(s)
- Anurag Pandey
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - K. Rajeshwari
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Deepak Kumar
- Department of Pediatrics, Maulana Azad Medical College and Associated Lok Nayak Hospital, New Delhi, India
| | - Garima Gupta
- Department of Pediatrics, ESIC Hospital, New Delhi, India
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Tohmatsu Y, Yamada M, Otsuka S, Ohgi K, Ashida R, Kurai H, Yasui H, Sugino T, Uesaka K, Sugiura T. Liver abscess caused by Clostridium perfringens after left hepatic trisectionectomy for perihilar cholangiocarcinoma: a case report. Surg Case Rep 2023; 9:111. [PMID: 37335427 DOI: 10.1186/s40792-023-01687-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/05/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Clostridium perfringens sepsis has been reported to have a rapid onset and severe clinical outcome. We herein report a case of C. perfringens sepsis associated with massive intravascular hemolysis after left hepatic trisectionectomy for perihilar cholangiocarcinoma. CASE PRESENTATION A 72-year-old woman underwent left hepatic trisectionectomy for perihilar cholangiocarcinoma. Her postoperative course was uneventful except for bile leakage. She was discharged on postoperative day (POD) 35. On POD 54, she was readmitted because of abdominal pain with a high fever. Although her vital signs were stable on arrival at the hospital, a laboratory examination showed a severe inflammatory reaction and hemolysis, and she had developed disseminated intravascular coagulation. Abdominal contrast-enhanced computed tomography showed a 70-mm irregular shape and low-density containing air in liver segment 6, which suggested a liver abscess. The abscess was immediately drained of pus containing air. The pus showed multiple Gram-positive bacilli, and two blood cultures showed Gram-positive bacilli and hemolysis. Empirical antibiotic therapy with vancomycin and meropenem was started because C. perfringens was detected from the preoperative bile culture. Four hours after arrival, tachypnea and decreased oxygen saturation were observed. Her general condition deteriorated rapidly with significant hypoglycemia, progressive acidosis, anemia, and thrombocytopenia. Despite rapid drainage and empiric therapy, she died six hours after her arrival. At autopsy, the abscess consisted of coagulation necrosis of liver cells with inflammatory cell infiltration, and clusters of Gram-positive large bacilli were observed in the necrotic debris. C. perfringens was detected in the drainage fluid and blood culture. She was diagnosed with a liver abscess and severe sepsis caused by C. perfringens and treated promptly, but the disease progressed rapidly and led to her death. CONCLUSIONS Sepsis caused by C. perfringens can progress rapidly and lead to death in a few hours, so prompt treatment is needed. When patients who have undergone highly invasive hepatobiliary-pancreatic surgery show hemolysis and hepatic abscesses with gas, C. perfringens should be considered the most likely bacterium.
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Affiliation(s)
- Yuuko Tohmatsu
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Mihoko Yamada
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan.
| | - Shimpei Otsuka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Katsuhisa Ohgi
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Hanako Kurai
- Division of Infectious Diseases, Shizuoka Cancer Center, Shizuoka, Japan
| | - Haruna Yasui
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takashi Sugino
- Division of Pathology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimo-Nagakubo, Nagaizumi-Cho, Sunto-Gun, Shizuoka, 411-8777, Japan
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Chang Y, Chen JH, Chen WL, Chung JY. Klebsiella pneumoniae invasive syndrome with liver abscess and purulent meningitis presenting as acute hemiplegia: a case report. BMC Infect Dis 2023; 23:397. [PMID: 37308846 DOI: 10.1186/s12879-023-08383-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/08/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae can infect a variety of sites, with the risk of infection being higher in the immunocompromised state such as diabetes mellitus. A distinct invasive syndrome has been detected mostly in Southeast Asia in the past two decades. A common destructive complication is pyogenic liver abscess that can be complicated by metastatic endophthalmitis as well as the involvement of the central nervous system, causing purulent meningitis or brain abscess. CASE PRESENTATION We report a rare case of an invasive liver abscess caused by K. pneumoniae, with metastatic infections of meninges. A 68-year-old man with type 2 diabetes mellitus presented to our emergency department as sepsis. Sudden disturbed consciousness was noticed with presentation of acute hemiplegia and gaze preference mimicking a cerebrovascular accident. CONCLUSIONS The above case adds to the scarce literature on K. pneumoniae invasive syndrome with liver abscess and purulent meningitis. K. pneumoniae is a rare cause of meningitis and should raise suspicions about the disease in febrile individuals. In particular, Asian patients with diabetes presenting with sepsis and hemiplegia prompt a more thorough evaluation with aggressive treatment.
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Affiliation(s)
- Yu Chang
- Department of Emergency Medicine, Cathay General Hospital, 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City 106, Taipei, Taiwan
| | - Jiann-Hwa Chen
- Department of Emergency Medicine, Cathay General Hospital, 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City 106, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Wei-Lung Chen
- Department of Emergency Medicine, Cathay General Hospital, 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City 106, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Jui-Yuan Chung
- Department of Emergency Medicine, Cathay General Hospital, 280, Sec. 4, Ren'ai Rd., Da'an Dist., Taipei City 106, Taipei, Taiwan.
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan.
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Obed A, Abuassi M, Alsakarneh S, Jaber F, Fakhri M, Abufares F, Bashir A, Syam M, Jarrad A, Abdelhadi O, Ghoz H. Does Liver Resection Remain a Viable Option in Patients With Pyogenic Liver Abscess? A Single-Center Experience. Gastroenterology Res 2023; 16:184-191. [PMID: 37351080 PMCID: PMC10284645 DOI: 10.14740/gr1611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/02/2023] [Indexed: 06/24/2023] Open
Abstract
Pyogenic liver abscesses (PLAs) are relatively rare but often fatal if left untreated. Antibiotic therapy combined with percutaneous procedures has replaced surgery as the cornerstone of treatment. However, open surgical drainage or liver resection may be a last resort. This study aimed to review our experience in treating PLA, with a focus on the conditions requiring partial liver resection as the last viable curative option. Medical records of patients with PLA admitted to Jordan Hospital between October 2014 through October 2020 were retrospectively reviewed. Medical and demographic data of all 43 patients admitted to our facility with a diagnosis of PLA were extracted. We reviewed these patients and extracted the cases that required surgical intervention. Four (three males and one female) of the 43 patients with PLA required surgical intervention. The underlying causes of liver abscesses were as follows: one traumatic due to shrapnel injury from an explosion, one following chemoembolization for hepatocellular carcinoma, and two patients with no apparent etiology. All patients were diagnosed with a computed tomography (CT) scan of the abdomen and pelvis with intravenous contrast. Two patients had negative cultures. All patients received broad-spectrum antibiotics, and all underwent CT- or ultrasound-guided percutaneous drainage or aspiration. All four patients required partial hepatic resection due to treatment failure or inaccessible percutaneous procedures with clinical improvement. Although antimicrobial and interventional therapy remains the primary treatment option in PLA, the surgical option with open surgical drainage or partial liver resection remains viable and curative in selected patients.
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Affiliation(s)
- Aiman Obed
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mohammad Abuassi
- Internal Medicine Department, Jordan Hospital, Amman, Jordan
- These authors contributed equally to this study
| | - Saqr Alsakarneh
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
- These authors contributed equally to this study
| | - Fouad Jaber
- Internal Medicine Department, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Mahmoud Fakhri
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Fadi Abufares
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Abdalla Bashir
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Mahmood Syam
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Anwar Jarrad
- Hepatobiliary and Transplant Surgery Department, Jordan Hospital, Amman, Jordan
| | - Ody Abdelhadi
- General Surgery Department, Jordan Hospital, Amman, Jordan
| | - Hassan Ghoz
- Gastroenterology Department, University of Missouri-Kansas City, Kansas City, MO, USA
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Agga GE, Galloway HO, Appala K, Mahmoudi F, Kasumba J, Loughrin JH, Conte E. Effect of continuous in-feed administration of tylosin to feedlot cattle on macrolide and tetracycline resistant enterococci in a randomized field trial. Prev Vet Med 2023; 215:105930. [PMID: 37163775 DOI: 10.1016/j.prevetmed.2023.105930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/12/2023]
Abstract
Liver abscess causes substantial economic loss to the beef cattle industry through liver condemnation, reduced animal performance, and carcass yield. Continuous in-feed use of tylosin is the most effective and a commonly used practice in beef cattle production to prevent liver abscess. However, such mass medication can increase the level of antimicrobial resistant bacteria. We investigated the effect of continuous in-feed use of tylosin in feedlot cattle on (i) concentrations and prevalence of erythromycin-resistant (ERYr) and tetracycline-resistant (TETr) enterococci; (ii) associated antimicrobial resistance genes (ARGs) for resistance; (iii) species distribution; iv) macrolide and tetracycline resistance gene concentrations; and (v) tylosin concentration. A cohort of weaned calves were randomized to receive tylosin-medicated feed (Tylosin; n = 10) or nonmedicated feed (Control; n = 10) for a full feedlot cycle. Feces, feed and pen-surface samples were collected and processed by culture, droplet digital PCR, and liquid chromatography/mass spectroscopy for bacterial enumeration, detection and characterization, ARG quantification, and tylosin concentration, respectively. Data were analyzed by mixed effects linear- or binary-regression models depending on the outcomes. Tylosin administration significantly increased fecal concentration (P < 0.001) and prevalence (P = 0.021) of ERYr enterococci and erm(B) gene concentration (P < 0.001), compared to the control group. Interestingly, tylosin administration significantly reduced (P = 0.037) fecal TETr enterococci concentration compared to the control group, with no significant effect (P = 0.758) on fecal tet(M) concentration. In both treatment groups, enterococci concentrations increased over time, peaking on 174 days in feed before returning to the baseline. ERYr enterococci concentration was significantly (P = 0.012) higher in tylosin medicated feeds, with no significant effect (P = 0.321) on TETr enterococci concentration. Pen-surface concentration of ermB was significantly (P = 0.024) higher in the tylosin group, with no significant effect (P > 0.05) on bacterial concentrations. Increased diversity and a shift in the composition of enterococcal species and ARGs were observed over time, although tylosin use did not significantly affect (P > 0.05) their prevalence. Tylosin concentration was significantly higher in the feces of tylosin administered cattle (P < 0.001) and medicated feed (P = 0.027), with numerically higher pen-surface concentration (P = 0.065) in the tylosin group. In conclusion, continuous in-feed use of tylosin in feedlot cattle increases macrolide resistant enterococci and its fecal excretion, while decreasing tetracycline resistance. Two medically important species, E. faecium and E. faecalis, were predominant regardless of resistance status or sample source. Risk-based approaches including label changes to limit tylosin use such as withdrawal period, and development of effective manure treatments are potential areas of research to reduce environmental and public health impacts.
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Affiliation(s)
- Getahun E Agga
- Food Animal Environmental Systems Research Unit, Agricultural Research Service, US Department of Agriculture, 2413 Nashville Road Building 5, Bowling Green, KY 42101, USA.
| | - Hunter O Galloway
- Department of Agriculture and Food Science, Western Kentucky University, Bowling Green, KY, USA
| | - Keerthi Appala
- Department of Chemistry, Western Kentucky University, Bowling Green, KY, USA
| | - Faranak Mahmoudi
- Department of Chemistry, Western Kentucky University, Bowling Green, KY, USA
| | - John Kasumba
- Department of Chemistry, Western Kentucky University, Bowling Green, KY, USA
| | - John H Loughrin
- Food Animal Environmental Systems Research Unit, Agricultural Research Service, US Department of Agriculture, 2413 Nashville Road Building 5, Bowling Green, KY 42101, USA
| | - Eric Conte
- Department of Chemistry, Western Kentucky University, Bowling Green, KY, USA
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Hassan B, Maree G, Hassan A. A toothpick inside the liver with no defined access: A rare cause of liver abscess. Int J Surg Case Rep 2023; 106:108271. [PMID: 37130480 PMCID: PMC10172779 DOI: 10.1016/j.ijscr.2023.108271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION Foreign body ingestion is not an uncommon occurrence, whereas the complications that may be generated by it are infrequent. The clinical manifestation range from nonspecific symptoms to life threatening conditions. Therefore, these cases continue to be challenging in diagnosis and treatment, especially items that are not radio-opaque. CASE PRESENTATION This article demonstrates a rare case of liver abscess induced by a toothpick with an unknown access. A 64-year-old woman was admitted to the Intensive Care Unit when she had developed a septic shock due to liver abscess and a conservative treatment was provided. After that, the patient underwent surgery to extract the foreign body. DISCUSSION Tracking the ingested foreign body is not always effortless. Computed Tomography scan plays a significant role in discovering foreign bodies located inside the liver. Surgical intervention is mostly required to remove the foreign body. CONCLUSION Foreign body presence inside the liver is a rare incident. The symptoms vary from case to another and whether it is silent or not, it is preferable to remove the foreign body.
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Affiliation(s)
- Bushra Hassan
- Faculty of Medicine, Tishreen University, Lattakia, Syria.
| | - Gulan Maree
- Paediatric surgery Department, Tishreen University Hospital, Lattakia, Syria
| | - AlYakzan Hassan
- General Surgery Department, Tishreen Hospital, Damascus, Syria
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Yazawa T, Igai H, Kamiyoshihara M, Shirabe K. Right basal bronchial fistula due to amebic infection: a case report. BMC Pulm Med 2023; 23:117. [PMID: 37060007 PMCID: PMC10103523 DOI: 10.1186/s12890-023-02412-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 03/31/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Pleuropulmonary amebiasis is the second most common form of extraintestinal invasive amebiasis, but cases that include bronchopleural fistula are rare. CASE PRESENTATION A 43-year-old male was referred to our hospital for liver abscess, right pleural effusion, and body weight loss. He was diagnosed with a bronchopleural fistula caused by invasive pleuropulmonary amebiasis and human immunodeficiency virus (HIV) infection. After initial medical treatment for HIV infection and invasive amebiasis, he underwent pulmonary resection of the invaded lobe. Intraoperative inspection revealed a fistula of the right basal bronchus in the perforated lung abscess cavity, but the diaphragm was intact. The patient was discharged on postoperative day 3 and was in good condition at the 1-year follow-up. CONCLUSIONS Clinicians should be aware that pleuropulmonary amebiasis can cause a bronchopleural fistula although it is very rare.
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Affiliation(s)
- Tomohiro Yazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan.
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Mitsuhiro Kamiyoshihara
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, 3-39-22, Showa-Machi, Maebashi, 371-8511, Gunma, Japan
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Zhang ZY, Sun JJ, Wang JH, Wang P, Liu BM, Xing JH, Liu J, Zhang DP, Kong ZZ, Zhang HT, Yu XY. Successful treatment of a severe Takotsubo syndrome case complicated by liver abscess. BMC Cardiovasc Disord 2023; 23:189. [PMID: 37038117 PMCID: PMC10088135 DOI: 10.1186/s12872-023-03145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/20/2023] [Indexed: 04/12/2023] Open
Abstract
The main manifestations of Takotsubo syndrome (TTS) are a spherical expansion of the left ventricle or near the apex and decreased systolic function. TTS is mostly thought to be induced by emotional stress, and the induction of TTS by severe infection is not often reported. A 72-year-old female patient with liver abscess reported herein was admitted due to repeated fever with a history of hypertension and impaired glucose tolerance. Her severe infection caused TTS, and her blood pressure dropped to 80/40 mmHg. IABP treatment was performed immediately and continued for 10 days, and comprehensive medication was administered. Based on her disease course and her smooth recovery, general insights and learnings may be: Adding to mental and other pathological stress reaction, serious infections from pathogenic microorganism could be of great important causation of stress reaction leading to TTS, while basic diseases such as coronary heart disease, hypertension, and diabetes were be of promoting factors; In addition to effective drug therapies for TTS, the importance of the timely using of IABP should be emphasized.
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Affiliation(s)
- Zhi-Yue Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
- Hebei North University, Zhangjiakou, 075000, Hebei, China
| | - Jin-Jin Sun
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China.
| | - Jun-Hua Wang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China.
| | - Peng Wang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Bai-Mei Liu
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Jun-Hua Xing
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Jun Liu
- Department of Research, Air Force Medical Center, 100142, Beijing, China
| | - Da-Peng Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Zhen-Zhen Kong
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Hai-Tao Zhang
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
| | - Xin-Ya Yu
- Department of Cardiology, Air Force Medical Center, 100142, Beijing, China
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Lahlou W, Bourial A, Maaouni T, Bensaad A, Bensahi I, Sabry M, Miguil M. Lactococcus lactis endocarditis and liver abscess in an immunocompetent patient: a case report and review of the literature. J Med Case Rep 2023; 17:115. [PMID: 36997999 PMCID: PMC10064683 DOI: 10.1186/s13256-022-03676-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/08/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Over the last two decades, several cases of infections caused by Lactococcus lactis have been reported. This Gram-positive coccus is considered non-pathogenic for humans. However, in some rare cases, it can cause serious infections such as endocarditis, peritonitis, and intra-abdominal infections. CASE PRESENTATION A 56-year-old Moroccan patient was admitted to the hospital because of diffuse abdominal pain and fever. The patient had no past medical history. Five days before his admission, he developed abdominal pain in the right lower quadrant along with chills and feverish sensations. Investigations showed a liver abscess, which was drained, and the microbiological study of the pus revealed Lactococcus lactis subsp. cremoris. Three days after admission, control computed tomography objectified splenic infarctions. Cardiac explorations were performed and showed a floating vegetation on the ventricle side of the aortic valve. We retained the diagnosis of infectious endocarditis according to the modified Duke criteria. The patient was declared afebrile on day 5 and the evolution was clinically and biologically favorable. Lactococcus lactis subsp. cremoris, formerly known as Streptococcus cremoris, is a rare cause of human infections. The first case of Lactococcus lactis cremoris endocarditis was reported in 1955. This organism includes three subspecies: lactis, cremoris, and hordniae. A MEDLINE and Scopus search showed only 13 cases of infectious endocarditis due to Lactococcus lactis, with subsp. cremoris identified in four of the cases. CONCLUSIONS To our knowledge, this is the first case report of the co-occurrence of Lactococcus lactis endocarditis and liver abscess. Despite its reported low virulence and good response to antibiotic treatment, Lactococcus lactis endocarditis must be considered a serious disease. It is imperative for a clinician to suspect this microorganism of causing endocarditis when they notice signs of infectious endocarditis in a patient with a history of consumption of unpasteurized dairy products or contact with farm animals. The finding of a liver abscess should lead to an investigation of endocarditis, even in previously healthy patients without obvious clinical signs of endocarditis.
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Affiliation(s)
- Wahib Lahlou
- Department of Polyvalent Resuscitation Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco.
| | - Abderrahim Bourial
- Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Taib Maaouni
- Department of Polyvalent Resuscitation Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Ahmed Bensaad
- Department of Visceral Surgery, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Ilham Bensahi
- Department of Cardiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Mohamed Sabry
- Department of Cardiology, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
| | - Mohamed Miguil
- Department of Polyvalent Resuscitation Unit, Cheikh Khalifa International University Hospital, Mohammed VI University of Sciences and Health, Casablanca, Morocco
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Saleem A, Almutairi M, Hassan A, Al-Shadidi N, Alshammari K. Cholecysto-hepatic fistula in type III gallbladder perforation: A rare etiology of liver abscess; case report. Int J Surg Case Rep 2023; 105:108002. [PMID: 36965442 PMCID: PMC10073879 DOI: 10.1016/j.ijscr.2023.108002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 03/14/2023] [Accepted: 03/17/2023] [Indexed: 03/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Gallbladder perforation (GBP) with cholecystohepatic fistula is an extremely rare complication of acute and/or chronic gallbladder diseases. Niemeier classified GBP into three types each characterized by specific signs and symptoms. Radiological investigations such as abdominal ultrasonography (USG) and computed tomography (CT) are crucial to evaluate and diagnosing GBP, while fistulae are usually identified intraoperatively. CASE PRESENTATION A 77-year-old female patient, with a background medical history of multiple comorbidities, presented to our hospital with a one-week history of abdominal pain. Laboratory investigations showed abnormal values. The abdominal CT scan revealed a mildly enlarged liver, distended gallbladder, and liver abscess. Then, ultrasound-guided aspiration was done, and the clinical picture was consistent with calcular cholecystitis complicated with liver abscess. So, laparoscopic cholecystectomy was decided and the intraoperatively detected fistula was excised. The resected perforated gallbladder was sent for histopathological studies. The postoperative period was uneventful. CLINICAL DISCUSSION GBP is an unusual entity that is categorized into three types. It is considered a gallbladder complication and surgical emergency. The clinical features of GBP are non-specific and radiological tools aid in diagnosis demonstration. In the presented case of type III GBP, cholecystohepatic fistula was detected and excised intraoperatively. CONCLUSION Due to the rare entity of type III GBP in association with liver abscess, we report the case of a 77-year-old female with right lower quadrant pain, found to be caused by type III GBP with cholecystohepatic fistula and liver abscess.
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Affiliation(s)
- Athary Saleem
- Department of General Surgery, Al-Adan Hospital, Kuwait.
| | | | - Ahmed Hassan
- Department of General Surgery, Al-Adan Hospital, Kuwait
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Masuda T, Kobashi K, Sugimoto R, Ishii H, Tsunemitsu K. Intrahepatic cholangiocarcinoma with a liver abscess due to hepatic actinomycosis. Surg Case Rep 2023; 9:43. [PMID: 36949213 PMCID: PMC10033780 DOI: 10.1186/s40792-023-01625-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Liver tumors with liver abscesses are unusual and rarely reported. In particular, studies of intrahepatic cholangiocarcinoma with liver abscesses due to hepatic actinomycosis have not been reported. CASE PRESENTATION A 73-year-old woman presented with swelling of the right hypochondrium. Computed tomography revealed a mass lesion that was continuous with the abdominal wall in the right lobe of the liver, suggesting a liver tumor invading the abdominal wall. A liver biopsy revealed intrahepatic cholangiocarcinoma with a liver abscess. The histopathological specimen contained bacterial masses of actinomycosis, and the cause of the liver abscess was determined to be hepatic actinomycosis. As a result of percutaneous drainage and antibiotic therapy, the part of the tumor attached to the abdominal wall disappeared; therefore, we assumed that most of the lesion was not cholangiocarcinoma but a liver abscess due to hepatic actinomycosis. Radical surgery for residual intrahepatic cholangiocarcinoma was performed after chemotherapy. Currently, the patient is alive without recurrence 2 years and 9 months after the operation. CONCLUSION We encountered a difficult-to-diagnose case of intrahepatic cholangiocarcinoma with a liver abscess due to hepatic actinomycosis. A needle biopsy allowed early diagnosis and percutaneous drainage was an effective treatment.
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Affiliation(s)
- Tomoya Masuda
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan.
| | - Kenta Kobashi
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Ryoma Sugimoto
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Hiroshi Ishii
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
| | - Kensuke Tsunemitsu
- Department of Surgery, Saiseikai Saijo Hospital, 269-1 Tsuitachi, Saijo-Shi, Ehime, 793-0027, Japan
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Pei N, Liu X, Jian Z, Yan Q, Liu Q, Kristiansen K, Li J, Liu W. Genome sequence and genomic analysis of liver abscess caused by hypervirulent Klebsiella pneumoniae. 3 Biotech 2023; 13:76. [PMID: 36748017 PMCID: PMC9898476 DOI: 10.1007/s13205-023-03458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 01/02/2023] [Indexed: 02/05/2023] Open
Abstract
Hypervirulent Klebsiella pneumoniae (hvKp) is an important pathotype with enhanced virulence features compared with classical K. pneumoniae (cKp). hvKp usually causes life-threatening infections in the community, often affecting young and healthy individuals. During the past few decades, hvKp-induced liver abscess has been increasingly reported in Asia and is emerging as a global disease. To better comprehend the molecular characteristics of hvKp-induced liver abscess and recognize the global dissemination of hypervirulent strains with resistance determinants, we sequenced the whole genome of 26 K. pneumoniae strains from patients with liver abscess (KLA) and investigated the clinical factors related to different phenotype groups. The epidemiology, virulence-related factors, and antimicrobial resistance determinants were also discussed. The age, gender, and whether being hospitalized showed no differences among the string-positive and -negative groups were also studied. The assembly and annotation suggested that most of the 26 new liver abscess-causing hvKp strains were ST23-K1 or ST86-K2, and only one of the strains exhibited multidrug resistance. Compared with the existing 36 global liver abscess genome sequences, higher sequence type and virulence gene diversity were found in the new genomes. The clinical characteristics and genomic data of the isolated strains will enrich our knowledge for comparative genomic studies, allowing the better understanding of hvKp characteristics and evolution.
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Affiliation(s)
- Na Pei
- BGI-Shenzhen, Shenzhen, 518083 China.,Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Xin Liu
- BGI-Shenzhen, Shenzhen, 518083 China
| | - Zijuan Jian
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Qun Yan
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Qingxia Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
| | - Karsten Kristiansen
- BGI-Shenzhen, Shenzhen, 518083 China.,Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Junhua Li
- BGI-Shenzhen, Shenzhen, 518083 China.,Shenzhen Key Laboratory of Unknown Pathogen Identification, Shenzhen, 518083 China
| | - Wenen Liu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, 410008 Hunan China
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Rivera-Cariño PJ, Rosa-Cortés P, Llopart-Herrera L, Acosta-Pumarejo E, Rey-Mejías L, Toro DH. Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 without Respiratory Manifestations. P R Health Sci J 2023; 42:81-84. [PMID: 36941104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
COVID-19 infection has been associated, particularly in severely ill patients requiring hospitalization, with a hypercoagulable state. The case presented herein was a 66-year-old man with SARS-CoV-2 infection who did not have any respiratory symptoms. He presented with the following clinical manifestations: portal vein and hepatic artery thrombosis, liver infarction, and a superimposed abscess of the liver. In this case, early detection and the administration of anticoagulants and antibiotics led to a significant improvement within weeks of the diagnosis. We encourage physicians to be aware of COVID-19-associated hypercoagulable state and its potential complications, regardless of the acuity of the presentation or the absence of respiratory symptoms.
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Affiliation(s)
| | - Pedro Rosa-Cortés
- Gastroenterology Department, VA Caribbean Healthcare System, San Juan, PR
| | | | | | - Luis Rey-Mejías
- Department of Internal Medicine, VA Caribbean Healthcare System, San Juan, PR
| | - Doris H Toro
- Chief of Medicine Service and Gastroenterology Training Program Director, VA Caribbean Healthcare System, San Juan, PR
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Justo I, Vega V, Marcacuzco A, Caso Ó, García-Conde M, Manrique A, Calvo J, García-Sesma Á, San Juan R, Fernández-Ruiz M, Rivas C, Calero MR, Jiménez-Romero C. Risk factors indicating the need for surgical therapy in patients with pyogenic liver abscesses. Langenbecks Arch Surg 2023; 408:97. [PMID: 36808482 PMCID: PMC9942623 DOI: 10.1007/s00423-023-02837-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Percutaneous drainage (PD) and antibiotics are the therapy of choice (non-surgical therapy [non-ST]) for pyogenic liver abscesses (PLA), reserving surgical therapy (ST) for PD failure. The aim of this retrospective study was to identify risk factors that indicate the need for ST. METHODS We reviewed the medical charts of all of our institution's adult patients with a diagnosis of PLA between January 2000 and November 2020. A series of 296 patients with PLA was divided into two groups according to the therapy used: ST (n = 41 patients) and non-ST (n = 255). A comparison between groups was performed. RESULTS The overall median age was 68 years. Demographics, clinical history, underlying pathology, and laboratory variables were similar in both groups, except for the duration of PLA symptoms < 10 days and leukocyte count which were significantly higher in the ST group. The in-hospital mortality rate in the ST group was 12.2% vs. 10.2% in the non-ST group (p = 0.783), with biliary sepsis and tumor-related abscesses as the most frequent causes of death. Hospital stay and PLA recurrence were statistically insignificant between groups. One-year actuarial patient survival was 80.2% in the ST group vs. 84.6% in the non-ST (p = 0.625) group. The presence of underlying biliary disease, intra-abdominal tumor, and duration of symptoms for less than 10 days on presentation comprised the risk factors that indicated the need to perform ST. CONCLUSIONS There is little evidence regarding the decision to perform ST, but according to this study, the presence of underlying biliary disease or an intra-abdominal tumor and the duration of PLA symptoms < 10 days upon presentation are risk factors that should sway the surgeons to perform ST instead of PD.
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Affiliation(s)
- Iago Justo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Viviana Vega
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Alberto Marcacuzco
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Óscar Caso
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - María García-Conde
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Alejandro Manrique
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Jorge Calvo
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Álvaro García-Sesma
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain
| | - Rafael San Juan
- Unit of Infectious Diseases, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Rivas
- Department of Thoracic Surgery and Lung Transplantation, Madrid, Spain
| | - María Rosa Calero
- Department of Radiology, "Doce de Octubre" Hospital, Research Institute (imas12), Madrid, Spain
| | - Carlos Jiménez-Romero
- Unit of HPB Surgery and Abdominal Organ Transplantation, "Doce de Octubre" University Hospital, 4ª Floor Ctra Andalucía Km 5,4, 28041, Madrid, Spain.
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Namikawa H, Oinuma KI, Yamada K, Kaneko Y, Kakeya H, Shuto T. Predictors of hypervirulent Klebsiella pneumoniae infections: a systematic review and meta-analysis. J Hosp Infect 2023; 134:153-160. [PMID: 36813165 DOI: 10.1016/j.jhin.2023.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/26/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Hypervirulent Klebsiella pneumoniae (hvKp) infections confer notable morbidity and mortality. Differential diagnosis to determine whether the infections are caused by either the hvKp or classical K. pneumoniae (cKp) strain is particularly important for undertaking optimal clinical care and infection control efforts. AIM To identify and assess the potential predictors of hvKp infections. METHODS PubMed, Web of Science, and Cochrane Library databases were searched for all relevant publications from January 2000 to March 2022. The search terms included a combination of the following terms: (i) Klebsiella pneumoniae or K. pneumoniae and (ii) hypervirulent or hypervirulence. A meta-analysis of factors for which risk ratio was reported in three or more studies was conducted, and at least one statistically significant association was identified. FINDINGS In this systematic review of 11 observational studies, a total of 1392 patients with K. pneumoniae infection and 596 (42.8%) with hvKp strains were evaluated. In the meta-analysis, diabetes mellitus and liver abscess (pooled risk ratio: 2.61 (95% confidence interval: 1.79-3.80) and 9.04 (2.58-31.72), respectively; all P < 0.001) were predictors of hvKp infections. CONCLUSION For patients with a history of the abovementioned predictors, prudent management, including the search for multiple sites of infection and/or metastatic spread and the enforcement of an early and appropriate source control procedure, should be initiated in consideration of the potential presence of hvKp. We believe that this research highlights the urgent need for increasing clinical awareness of the management of hvKp infections.
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Affiliation(s)
- H Namikawa
- Department of Medical Education and General Practice, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan.
| | - K-I Oinuma
- Department of Bacteriology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Research Center for Infectious Disease Sciences, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - K Yamada
- Research Center for Infectious Disease Sciences, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Department of Infection Control Science, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - Y Kaneko
- Department of Bacteriology, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Research Center for Infectious Disease Sciences, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - H Kakeya
- Research Center for Infectious Disease Sciences, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan; Department of Infection Control Science, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
| | - T Shuto
- Department of Medical Education and General Practice, Osaka Metropolitan University, Graduate School of Medicine, Osaka, Japan
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Robateau Colón A, Higgins E, Boire N, Cummins N, Watt KD. Non-tuberculous mycobacteria infection presenting as a hepatic allograft abscess. IDCases 2023; 31:e01722. [PMID: 36860283 PMCID: PMC9969053 DOI: 10.1016/j.idcr.2023.e01722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
Nontuberculous mycobacteria (NTM) are mycobacterial species other than Mycobacterium tuberculous and Mycobacterium leprae [1]. They are environmental organisms which have been implicated in a wide array of clinical syndromes. Here we describe a case of a Mycobacterium fortuitum complex liver abscess in a liver transplant recipient.
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Affiliation(s)
| | - Eibhlin Higgins
- Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Nicholas Boire
- Division of Anatomical and Clinical Pathology, Mayo Clinic, Rochester, MN, USA
| | - Nathan Cummins
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA,Division of Public Health, Infectious Diseases and Occupational Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kymberly D. Watt
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA,Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA,Correspondence to: Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Nham E, Lee JH, Huh K, Ko JH, Cho SY, Kang CI, Chung DR, Huh HJ, Lee NY, Peck KR. Predictive and prognostic factors associated with unliquefied pyogenic liver abscesses. J Microbiol Immunol Infect 2023; 56:64-74. [PMID: 35995667 DOI: 10.1016/j.jmii.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/05/2022] [Accepted: 07/30/2022] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Poor liquefaction of pyogenic liver abscesses, which makes drainage impossible at the time of diagnosis, is not infrequent. The impact of poor liquefaction and subsequent drainage failure on clinical outcomes is unknown. METHODS We conducted a retrospective study with all patients diagnosed with liver abscesses from July 2017 through June 2020. Late drainage (LD) was defined as drainage performed ≥48 h after diagnosis due to poor liquefaction. Logistic regression was performed to identify the factors associated with late or non-drainage (LD/ND). The Cox proportional hazard model was used to identify the variables related to abscess recurrence by 90 days after diagnosis. RESULTS A total of 153 patients were included. Thirty (19.6%) patients underwent LD and 54 (35.3%) did not undergo drainage. Other than non-cystic appearance, LD/ND was associated with smaller size (adjusted odds ratio [aOR] 0.85, 95% confidence interval [CI] 0.73-0.98, p = 0.031) and culture-negativity (aOR 2.69, 95% CI 1.14-6.67, p = 0.027). Current hepatopancreaticobiliary malignancy was the only significant predictor of 90-day recurrence. Neither LD/ND (OR, 0.56; 95% CI, 0.13-2.41; p = 0.426) nor LD (OR, 1.26; 95% CI, 0.23-5.55; p = 0.719) was associated with recurrence by 90 days. The incidence of late complications was reduced by drainage, without a reduction in the duration of hospitalization. CONCLUSION Several clinical features were associated with undrainable liver abscesses. Neither LD/ND nor ND had an adverse impact on clinical outcomes.
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Lim J, Zaw C, Abramson S, Lichtenberger PN, John BV, Cuebas-Rosado L. Clostridium difficile Bacteremia as a Rare Presentation of Polymicrobial Pyogenic Liver Abscesses and Its Management Challenges. Case Rep Gastroenterol 2023; 17:264-268. [PMID: 37928967 PMCID: PMC10624945 DOI: 10.1159/000531892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 06/27/2023] [Indexed: 11/07/2023] Open
Abstract
Extracolonic manifestations of Clostridium difficile have been rarely reported. We herein report a case of a 60-year-old immunocompetent man presenting with fever, nausea, abdominal pain, and loose stools for 2 weeks. Triple-phase liver computed tomography demonstrated pyogenic liver abscesses and portal pylephlebitis. Blood cultures grew C. difficile and Bacteroides fragilis, and liver abscess cultures grew Proteus mirabilis, Escherichia coli, and the viridans group Streptococci. Antibiotics coverage was selected to direct at all identified organisms. This demonstrates an unusual case of C. difficile bacteremia in a patient with polymicrobial pyogenic liver abscesses and pylephlebitis.
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Affiliation(s)
- Junghyun Lim
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Catherine Zaw
- Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA
| | - Simon Abramson
- Veterans Health Affairs National Teleradiology Program, Menlo Park, CA, USA
| | | | - Binu V. John
- Division of Hepatology, Bruce W. Carter VA Medical Center, Miami, FL, USA
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Chen Y, Lai X, Zhu Y, Wang M, He Y. Changes in clinical and CT manifestations related to liver abscesses in patients with vs. without basic diabetes mellitus before and after CT-guided interventional therapy: An observational study. Clinics (Sao Paulo) 2023; 78:100164. [PMID: 36657253 PMCID: PMC9868336 DOI: 10.1016/j.clinsp.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/16/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To explore differences in the changes of clinical and CT manifestations related to liver abscess before and after CT-guided interventional therapy between patients with and without Diabetes Mellitus (DM). MATERIALS AND METHODS Fifty-eight consecutive patients with liver abscesses were retrospectively enrolled in this study. All patients underwent upper abdominal contrast-enhanced CT scans before and after CT-guided interventional therapy. They were divided into two groups including the DM group (n=30) and the Non-DM group (n=28) if the liver abscess occurred in patients with and without DM, respectively. The changes in the clinical and CT manifestations related to liver abscess after CT-guided interventional therapy in both groups were statistically analyzed. RESULTS After CT-guided interventional therapy, the length of hospital stay, white blood cell recovery time and drainage tube removal time in the DM group were longer than in the Non-DM group (all p-values < 0.05). The incidence of postoperative complications in the DM group was higher than in the Non-DM group (p < 0.05). As shown on CT, the postoperative reduced percentage of maximum diameter of abscess cavity and the reduction rate of edema band surrounding the liver abscess in the DM group were smaller than in the Non-DM group (both p-values < 0.05). The time intervals of the previous characteristic changes on CT before and after interventional therapy in the DM group were longer than in the Non-DM group (all p-values < 0.05). CONCLUSIONS The liver abscesses patients with DM could not have a faster recovery and better therapeutic effect than those without DM after the CT-guided interventional therapy.
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Affiliation(s)
- Yuxiang Chen
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Xunfu Lai
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yuping Zhu
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Mengting Wang
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China
| | - Yulin He
- Department of Radiology, First Affiliated Hospital of Nanchang University; Jiangxi Medical College, Nanchang University, Nanchang, China.
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Kadi A, Tuergan T, Abulaiti Y, Shalayiadang P, Tayier B, Abulizi A, Tuohuti M, Ahan A. Laparoscopic treatment of pyogenic liver abscess caused by fishbone puncture through the stomach wall and into the liver: A case report. World J Clin Cases 2022; 10:13402-13407. [PMID: 36683634 PMCID: PMC9850996 DOI: 10.12998/wjcc.v10.i36.13402] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/28/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pyogenic liver abscess (PLA) due to foreign body penetration of the gastrointestinal tract is rare but can lead to serious consequences if not diagnosed and managed properly. We report a case of PLA caused by a fishbone puncture.
CASE SUMMARY This report describes the clinical features, diagnosis and treatment of a 56-year-old male patient who presented with severe pneumonia, acute respiratory failure and septic shock. The main clinical manifestation was a nonspecific recurrent infection. Based on the findings of abdominal computed tomography examination and the detailed medical history, the diagnosis was made as PLA which was caused by fishbone puncture through the stomach wall and into the liver. After active anti-inflammatory treatment, the patient's general condition had improved. The laparoscopic drainage of the liver abscess and the foreign body removal was performed. There was no recurrence of abscess at discharge or during follow-up and the patient’s general condition was satisfactory.
CONCLUSION PLA caused by foreign bodies usually requires surgical treatment or percutaneous drainage combined with antibiotics. Our case confirms that a laparoscopic approach is safe and feasible for such cases.
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Affiliation(s)
- Abudureyimu Kadi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Talaiti Tuergan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Yierpan Abulaiti
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Paizula Shalayiadang
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Baihetiyaer Tayier
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Abududuaini Abulizi
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
| | - Muniremu Tuohuti
- Department of General Medicine, First People's Hospital of Aksu Region, Aksu 843099, Xinjiang Uygur Autonomous Region, China
| | - Ayifuhan Ahan
- Department of Hepatobiliary and Hydatid Disease, Digestive and Vascular Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China
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Alzibdeh AH, Alamami AA, Adam M, Almaslamani M, Hadi HA. A complex presentation of an uncommon disease: Gas-forming pyogenic liver abscess complicated by septic pulmonary emboli and muscle abscesses, a case report and review of the literature. IDCases 2022; 31:e01673. [PMID: 36632483 PMCID: PMC9827024 DOI: 10.1016/j.idcr.2022.e01673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background Pyogenic liver abscess (PLA) is the most common type of visceral abscess. Its variable clinical presentation depends on patient demography, underlying conditions, causative pathogens as well as the size of the abscess. Most cases are secondary to enteric pathogens that cause focal liver disease. Gas-forming pyogenic liver abscess (GFPLA) is a rare subgroup of PLA characterized by the presence of gas within the abscess. The disease is associated with diabetes mellitus (DM) while Klebsiella penumoniae is the most frequently isolated pathogen. Despite appropriate evaluation and management, secondary complications are common with significant morbidity and mortality that necessitate prompt recognition and management. Case presentation We present a case of a 46-year-old gentleman from Bangladesh who presented to the emergency department with fever, chills, and right upper quadrant abdominal discomfort. Evaluation revealed elevated inflammatory markers with high blood glucose and a subdiaphragmatic lucency on a plain chest radiograph. The suspected underlying visceral infection was confirmed by abdominal ultrasonography and computed tomography which demonstrated an emphysematous abscess of 8 cm in diameter in the right liver lobe.Because of clinical instability, the patient was admitted to the medical intensive care unit (MICU) where he received appropriate supportive management with antimicrobials and percutaneous drainage of the abscess. Cultures collected from blood, the abscess, and urine grew a sensitive strain of Klebsiella pneumoniae. During his stay in the MICU, he complained of dyspnea. A CT pulmonary angiography was suggestive of septic emboli. A few days later, the patient started to complain of left gluteal pain and an US revealed a deep left gluteal abscess which required drainage. Cultures of the pus grew the same sensitive strain of Klebsiella pneumoniae. After receiving 6 weeks of parenteral antimicrobial therapy a repeated US revealed complete resolution of the abscess in the liver. Outpatient follow up showed favorable recovery. Conclusion Gas-forming pyogenic liver abscess (GFPLA) is a rare manifestation of pyogenic liver abscess that usually occurs in patients with poorly controlled DM. Despite appropriate evaluation, morbidity remains high therefore timely recognition and anticipation of complications is important.
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Affiliation(s)
- Aseel H. Alzibdeh
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar,Correspondence to: Hamad Medical Corporation, P O Box 3050, Doha, Qatar.
| | - Ans A. Alamami
- Department of Critical Care, Hamad General Hospital, Hamad Medical Corporation, Qatar
| | - Mohammad Adam
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar
| | - Muna Almaslamani
- Communicable Diseases Centre, Hamad Medical Corporation, Qatar,Weill Cornell Medicine Qatar, Qatar
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Ishihara Y, Kaneshiro S, Ikehara Y. Giant liver abscess with Streptococcus intermedius bacteremia treated without any drainage. IDCases 2022; 31:e01662. [PMID: 36589763 PMCID: PMC9801097 DOI: 10.1016/j.idcr.2022.e01662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
A 66-year-old man with hypertension presented with fever which has started three days prior. Computed tomography (CT) revealed the presence of multiple low-density areas in the liver, the largest of which was over 10 cm in diameter, with clear demarcation. Streptococcus intermedius was detected in the blood culture, thus we diagnosed suspected liver abscess with bacteremia. Because the patient refused invasive drainage and was not poor general appearance, we had initiated intravenous meropenem followed by ceftriaxone plus metronidazole without any abscess drainage. After 6 weeks antibiotics treatment, liver abscess was almost completely diminished on the CT scan. To the best of our knowledge, this is the first report of a giant liver abscess caused by Streptococcus intermedius treated successfully without drainage.
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Affiliation(s)
- Yo Ishihara
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kamakura, Japan,Correspondence to: Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, Kanagawa 247-8533, Japan.
| | - Sayaka Kaneshiro
- Department of General Internal Medicine, Uji Tokushukai Hospital, Kyoto, Japan
| | - Yasukazu Ikehara
- Department of Surgery, Ishigakijima Tokushukai Hospital, Okinawa, Japan
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Feng J, Hsu WC, Chang DH, Hsu CH. Ruptured liver abscess causing necrotizing soft-tissue infection of the abdominal wall mimicking a carbuncle: A case report. Asian J Surg 2022:S1015-9584(22)01712-2. [PMID: 36509596 DOI: 10.1016/j.asjsur.2022.11.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jie Feng
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Chun Hsu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dun-Hao Chang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Plastic and Aesthetic Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
| | - Chih-Ho Hsu
- Division of General Surgery, Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
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Lee JY, Park JW, Park JY. Liver Abscess caused by Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome. Infect Chemother 2022; 54:803-807. [PMID: 32869553 PMCID: PMC9840953 DOI: 10.3947/ic.2020.0206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 06/01/2018] [Indexed: 02/01/2023] Open
Abstract
Cytomegalovirus (CMV) causes severe infection in immunocompromised patients, especially those with acquired immunodeficiency syndrome (AIDS), those who have undergone organ transplantation, and/or those who are being treated with steroids. In patients with AIDS, CMV is the most common pathogen that causes opportunistic infections. Here, we present a case of liver abscess due to CMV in a 58-year-old man diagnosed with AIDS. At the time of the study, his CD4 T lymphocyte count was 39 cells/mm3, and his human immunodeficiency virus (HIV) ribonucleic acid (RNA) level was 411,000 copies/mL. Upon presentation, he complained of upper abdominal pain. Ultrasonography-guided percutaneous drainage of the liver abscess was performed, and polymerase chain reaction analysis of the drained pus was positive for CMV. He was treated with intravenous ganciclovir, after which he recovered fully. In conclusion, our patient represents, to our knowledge, the first described case of liver abscess caused by CMV in an AIDS patient, which was probably facilitated by severe immunodeficiency.
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Affiliation(s)
- Jin Young Lee
- Department of Internal Medicine, Kosin Medical College, Busan, Korea
| | - Jong woo Park
- Department of Emergency Medicine, Kosin University Gospel Hospital, Busan, Korea
| | - Ji Young Park
- Department of Internal Medicine, Kosin University Gospel Hospital, Busan, Korea
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Oe H, Watanabe M, Sasaki M, Miyamoto Y, Okada N, Matsuyama T, Ohta B. Varicella-zoster virus meningitis coincident with bacteremia caused by liver abscess: a case report. J Neurovirol 2022; 28:606-608. [PMID: 36112241 DOI: 10.1007/s13365-022-01086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 04/12/2022] [Accepted: 06/20/2022] [Indexed: 01/13/2023]
Abstract
Varicella-zoster virus (VZV) meningitis is sometimes associated with herpes zoster, which is also associated with various other infectious diseases. However, there are limited case reports of VZV meningitis with concomitant infectious diseases. Herein, we report a unique case of VZV meningitis concomitant with a pyogenic liver abscess. VZV meningitis was associated with herpes zoster ophthalmicus, Klebsiella pneumoniae bacteremia, and liver abscess. When VZV meningitis is suspected, clinicians should be aware of its relatively rare epidemiology, nonspecific presentation, and many background risks shared with other infections and should never omit thorough examinations to rule out other infectious causes.
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Affiliation(s)
- Hikaru Oe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Makoto Watanabe
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Makoto Sasaki
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Bon Ohta
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kaji-cho 465, Kamigyo-ku, Kyoto, 602-8566, Japan
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Ren M, Zhou X, Lv L, Ji F. Endoscopic Bariatric and Metabolic Therapies for Liver Disease: Mechanisms, Benefits, and Associated Risks. J Clin Transl Hepatol 2022; 10:986-994. [PMID: 36304503 PMCID: PMC9547260 DOI: 10.14218/jcth.2021.00448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/02/2022] [Accepted: 01/11/2022] [Indexed: 12/04/2022] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), including advanced-stage nonalcoholic steatohepatitis (NASH), is currently the most common chronic liver disease worldwide and is projected to become the leading indication for liver transplantation (LT). However, there are no effective pharmacological therapies for NAFLD. Endoscopic bariatric and metabolic therapies (EBMTs) are less invasive procedures for the treatment of obesity and its metabolic comorbidities. Several recent studies have demonstrated the beneficial effects of EBMTs on NAFLD/NASH. In this review, we summarize the major EBMTs and their mechanisms of action. We further discuss the current evidence on the efficacy and safety of EBMTs in people with NAFLD/NASH and obese cirrhotic LT candidates. The potential utility of EBMTs in reducing liver volume and perioperative complications in bariatric surgery candidates is also discussed. Moreover, we review the development of liver abscesses as a common serious adverse event in duodenal-jejunal bypass liner implantation.
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Affiliation(s)
| | | | | | - Feng Ji
- Correspondence to: Feng Ji, Department of Gastroenterology, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, Zhejiang 310003, China. ORCID: https://orcid.org/0000-0002-1426-0802. Tel: +86-571-87236863, Fax: 86-571-87236611, E-mail:
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Shinmoto K, Ohbe H, Nakajima M, Miyamoto Y, Sasabuchi Y, Yasunaga H, Hiraoka E. Outcomes after early versus delayed antibiotic treatment of liver abscess in Japan: A nationwide retrospective cohort study. J Infect Chemother 2022; 29:1-6. [PMID: 36089258 DOI: 10.1016/j.jiac.2022.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/09/2022] [Accepted: 08/31/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The optimal timing of antibiotic administration in patients with a liver abscess undergoing liver aspiration or drainage is unknown. METHODS This was a retrospective cohort study using the Diagnosis Procedure Combination database, a national inpatient database in Japan. RESULTS A total of 34,424 patients who were emergently hospitalized due to liver abscess between July 2010 and March 2020 were included. Of these, 31,248 (90.8%) received antibiotics on the day of admission (early antibiotics group), and 3176 (9.2%) did not (delayed antibiotics group). Multivariable logistic regression analyses showed that in-hospital mortality of patients in the early antibiotics group was significantly lower than that in the delayed antibiotics group (odds ratio, 0.61; 95% confidence interval, 0.52-0.72; p <0.001). Patients in the early antibiotics group had a significantly lower proportion of clinical deterioration (odds ratio, 0.73; 95% confidence interval, 0.63-0.84; p <0.001) and shorter length of stay (adjusted difference, -5.2 days; 95% confidence interval, -6.2 to -4.1 days; p <0.001) than those in the delayed antibiotics group. CONCLUSIONS Starting antibiotic treatment on the day of admission was associated with lower mortality, a lower proportion of clinical deterioration, and a shorter length of hospital stay.
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Affiliation(s)
- Keito Shinmoto
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Mikio Nakajima
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Emergency Life-Saving Technique Academy of Tokyo, Foundation for Ambulance Service Development, 4-5, Minami-Osawa, Hachioji-shi, Tokyo, 192-0364, Japan
| | - Yuki Miyamoto
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajii-cho Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Yusuke Sasabuchi
- Data Science Center, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi Prefecture, 3290498, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32, Todaijima, Urayasu, Chiba, 279-0001, Japan
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