目的:化脓性肝脓肿(PLA)是由多种病原体引起的常见外科感染性疾病。肺炎克雷伯菌是一种相对较新的病因,常影响免疫力低下的患者。内源性眼内炎(EE),一种罕见且严重的PLA并发症,在PLA之前可能出现眼部症状。通过回顾1例肺炎克雷伯菌诱导的PLA合并EE的病例,我们想总结有关特征的信息,原因,基于文献综述的PLA并发症。
方法:本病例报告描述了一名37岁男性高烧至39°C持续10天,出现视力模糊,随后出现非光线感知视力。他报告有糖尿病史,不定期服用口服药物和胰岛素治疗。影像学检查发现肝脏右叶有一个大的低密度区域,边界不清,周围脂肪间隙模糊。血培养不是阳性。肝穿刺引流液培养显示肺炎克雷伯菌。取血和肝穿刺引流液,采用新一代测序技术(NGS)进行微生物高通量基因检测,证实肺炎克雷伯菌诱导的PLA合并EE的诊断。
结果:患者的手术切口在出院时愈合良好,他能感觉到左眼有光线.但患者出院后第三个月就失去了随访。
结论:通过回顾该病例并总结有关特征的信息,原因,基于文献综述的PLA并发症,我们的结论是,有必要及时进行肝穿刺引流术和经验使用抗生素对PLA患者,尤其是那些血糖控制不佳的人,避免EE等严重并发症。
Pyogenic liver abscess (PLA) is a common surgical infectious disease caused by various pathogens. Klebsiella pneumoniae is a relatively recent cause, often affecting patients with low immunity. Endogenous endophthalmitis (EE), a rare and serious complication of PLA, may appear with eye symptoms before PLA. By reviewing a case of Klebsiella pneumoniae-induced PLA complicated with EE, we want to summarize the information about the characteristics, causes, and complications of PLA based on the literature
review.
This case report describes a 37-year-old male who had fever high to 39°C for 10 days experienced blurred vision followed by nonlight perception vision. He reported a history of diabetes irregularly taking oral medications and insulin therapy. Imaging examination found a large low-density area in the right lobe of the liver with an unclear border and vague surrounding fat gap. The blood culture was not positive. The culture of the drainage fluid from the liver puncture showed Klebsiella pneumonia. Blood and liver puncture drainage fluid were sent for microbial high-throughput gene detection with next-generation sequencing technology (NGS), which confirmed the diagnosis of Klebsiella pneumoniae-induced PLA complicated with EE.
The patient\'s surgical incision had healed well at discharge, and he could feel light at his left eye. But the patient was lost to follow-up since the third month after discharge.
By reviewing this case and summarize the information about the characteristics, causes, and complications of PLA based on the literature
review, we concluded that it is necessary to promptly perform liver puncture drainage and empirically use antibiotics for patients with PLA, especially those with poor glycemic control, to avoid serious complications such as EE.