PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
未经授权：化脓性肝脓肿（PLA）是最常见的内脏脓肿类型。其可变的临床表现取决于患者的人口统计学，潜在条件，病原体以及脓肿的大小。大多数病例继发于引起局灶性肝病的肠道病原体。气体形成化脓性肝脓肿（GFPLA）是一种罕见的PLA亚组，其特征是脓肿内存在气体。该疾病与糖尿病（DM）有关，而肺炎克雷伯菌是最常见的病原体。尽管进行了适当的评估和管理，继发性并发症很常见,发病率和死亡率高,需要及时识别和处理.
UNASISIGNED：我们介绍了一个来自孟加拉国的46岁绅士因发烧向急诊科就诊的案例，发冷,右上腹不适。评估显示，在胸部平片上，炎症标志物升高，血糖升高，膈下清醒。通过腹部超声检查和计算机断层扫描证实了可疑的潜在内脏感染，这表明右肝叶有直径8厘米的肺气肿脓肿。由于临床不稳定，患者被送进医疗重症监护病房(MICU),在那里他接受了适当的支持性治疗,包括抗菌药物和脓肿经皮引流.从血液中收集的培养物，脓肿,尿液中培养了敏感的肺炎克雷伯菌。在MICU期间,他抱怨呼吸困难。CT肺动脉造影提示败血症栓子。几天后,患者开始抱怨左臀肌疼痛,美国人发现左臀肌脓肿深,需要引流.脓液培养出相同的肺炎克雷伯菌敏感菌株。在接受6周的肠胃外抗菌治疗后，反复的US显示肝脏脓肿完全消退。门诊随访显示恢复良好。
UNASSIGNED：气体形成化脓性肝脓肿（GFPLA）是化脓性肝脓肿的罕见表现，通常发生在DM控制不佳的患者中。尽管进行了适当的评估，发病率仍然很高，因此及时识别和预测并发症很重要。
UNASISIGNED：我们介绍了一个来自孟加拉国的46岁绅士因发烧向急诊科就诊的案例，发冷,右上腹不适。评估显示，在胸部平片上，炎症标志物升高，血糖升高，膈下清醒。通过腹部超声检查和计算机断层扫描证实了可疑的潜在内脏感染，这表明右肝叶有直径8厘米的肺气肿脓肿。由于临床不稳定，患者被送进医疗重症监护病房(MICU),在那里他接受了适当的支持性治疗,包括抗菌药物和脓肿经皮引流.从血液中收集的培养物，脓肿,尿液中培养了敏感的肺炎克雷伯菌。在MICU期间,他抱怨呼吸困难。CT肺动脉造影提示败血症栓子。几天后,患者开始抱怨左臀肌疼痛,美国人发现左臀肌脓肿深,需要引流.脓液培养出相同的肺炎克雷伯菌敏感菌株。在接受6周的肠胃外抗菌治疗后，反复的US显示肝脏脓肿完全消退。门诊随访显示恢复良好。
UNASSIGNED：气体形成化脓性肝脓肿（GFPLA）是化脓性肝脓肿的罕见表现，通常发生在DM控制不佳的患者中。尽管进行了适当的评估，发病率仍然很高，因此及时识别和预测并发症很重要。
