Emphysematous liver abscess with hepatic portal venous gas

Excerpt

A 59-year-old man with type 2 diabetes mellitus presented to our emergency department with a 3-day history of chills, fever, malaise, and poor dietary intake. Physical examination revealed a body temperature of 38.5 °C, pulse rate of 73 beats/min, respiratory rate of 16 breaths/min, and blood pressure of 133/71 mmHg. Neither chest nor abdominal pain was noted. Laboratory examinations yielded a white blood cell count of 6980 cells/mm³ with 80% neutrophils, a platelet cell count of 11,000/mm³, C-reactive protein level of 40.7 mg/dL (reference range: < 0.3 mg/dL), blood glucose level of 534 mg/dL, and glycosylated hemoglobin level of 11.8%. A chest radiograph revealed obscure gas formation in the right subphrenic area. Computed tomography (CT) of the abdomen revealed a huge emphysematous liver abscess (ELA; size, 12 × 6 cm²) in the right lobe of the liver, along with hepatic portal venous gas (HPVG) in the left lobe of the liver (Fig. 1). No other abdominal abnormality was noted. Antimicrobial therapy with a third-generation cephalosporin was initiated. A pigtail catheter was inserted for drainage the ELA. Both blood and drainage pus cultures revealed pan-drug-susceptible Klebsiella pneumoniae with identical antimicrobial susceptibility. Antiamoebic antibody test yielded negative result. The ELA gradually reduced in size after treatment, and HPVG disappeared on hospital day 10. However, right pleural effusion occurred, which progressively loculated over the following days. Video-assisted thoracoscopic surgical decortication was performed on hospital day 16. Pleural empyema pus culture was positive for K. pneumoniae. A third-generation cephalosporin was administered for 4 weeks. The patient was discharged in a favorable condition on hospital day 28.

…