Roger Williams Medical Center Providence, RI, United States
Navya Kirla, MD, Dong Joo Seo, MD, Praneet Srisailam, MD, Adderly Toribio, MD Roger Williams Medical Center, Providence, RI
Introduction: Pyogenic liver abscess (PLA) is potentially fatal with an incidence of about 1 in 45 to 100,000, with a significant mortality rate of 6% to 19.6%. The most frequent isolated microorganisms are Escherichia(E) Coli and streptococcus millery group. In the past 2 decades, Klebsiella pneumonia has been reported to be the most common pathogen causing PLA, especially in Asia and the US with a higher probability of hematogenous spread and metastatic infection.
Case Description/Methods: A 38-year-old female with a history of cholecystectomy, complicated by biliary leak and stenosis in common hepatic duct status post ERCP with stent placement. A few weeks later, the patient developed pyogenic liver abscess growing Klebsiella pneumonia, confirmed by CTAP (CT of abdomen and pelvis) and blood culture. She was placed on 1 week course of antibiotics after CT guided aspiration and got discharged. 3 months later, the patient presented with flank pain. Ultrasound of the abdomen did not show any signs of abscess. However, blood culture grew K. pneumonia for which she was given another 1 week course of antibiotics. A week later, she comes back again with a chief complaint of abdominal pain, pleuritic chest pain with fever and chills. Repeat CT scan showed hypodensity in the lateral mid right hepatic lobe, suggestive of abscess. CTPA showed peripheral filling defect and nodular changes in the right lower lobe in which septic emboli is highly likely.
Discussion: As complications of liver abscesses due to high rates of bacteremia, patients can sometimes develop pulmonary septic embolism, caused by clots, fibrin matrix, and micro-organisms. Other complications include right sided endocarditis, pelvis thrombophlebitis. The main features on CT scans on septic pulmonary emboli are feeding vessel sign (79%), nodules with or without cavitations (79%), and subpleural wedge shaped subpleural opacities (64%). Abdominal imaging raises high suspicion of this condition. CT is more sensitive than ultrasound for liver abscesses (approximately 95 versus 85 percent). A key component of the management is drainage of abscess guided by either CT or ultrasound, ERCP, followed by an appropriate duration of the antibiotics. If the location is difficult to be accessed, open surgical drainage, laparoscopic drainage should be indicated. Antibiotics therapy should be continued for 2 to 4 weeks for complete drainage and 4 to 6 weeks for incomplete drainage.
Navya Kirla indicated no relevant financial relationships.
Dong Joo Seo indicated no relevant financial relationships.
Praneet Srisailam indicated no relevant financial relationships.
Adderly Toribio indicated no relevant financial relationships.
Navya Kirla, MD, Dong Joo Seo, MD, Praneet Srisailam, MD, Adderly Toribio, MD. P0803 - Septic Pulmonary Emboli From Pyogenic Liver Abscess After Cholecystectomy, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.