Presentation
Abdominal pain, nausea, vomiting, diarrhea and fever since one month ago. Leukocytosis and elevated CRP.
Patient Data
Hypoechoic collection with irregular borders in the right hepatic lobe of approximately 80 mm. It was decided to complete the study by CT scan.
Hypodense collection with peripheral enhancement in the right hepatic lobe with a diameter of 100 mm. Similar lesions are observed in lower segments. Slight amount of perihepatic free fluid and fat stranding.
Cholelithiasis. No thrombosis.
Clinical, laboratory and imaging tests suggest hepatic abscesses. It was decided to place a drainage catheter, with the outflow of purulent content. The laboratory sample was positive for Klebsiella pneumoniae.
During the admission, the patient was diagnosed with diabetes mellitus.
A control CT scan 2 weeks later. Reduction in size of liver abscesses. Presence of drainage catheter.
Case Discussion
A hepatic abscess (HA) is defined as an encapsulated collection of suppurative material within the liver parenchyma. The majority of HAs are pyogenic. The most relevant bacteria are E.coli, Klebsiella, Streptococcus, Staphylococcus, and anaerobes. The main dissemination routes are leakage from the bowel that travels up to the liver through the portal vein or by infected gallbladder and/or biliary tract. The right hepatic lobe is more prone to be affected due to increased blood supply.
There are many risk factors associated with the development of HA. One of the most important is diabetes mellitus (DM). DM, as in immunocompromised states, weakens the immune system against infections. Diabetic patients are prone to present with multiple abscesses, as this case shows.
Treatment consists of drainage (normally under CT or US) and antibacterial therapy. Despite empiric antibiotic coverage, it is essential to obtain laboratory samples to adjust antibiotic regimens if necessary.
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