Liver abscesses are defined as a collection of pus in the liver.
Dr. María Cochran Pérez and Dr. Kattya Cruz, assigned to the Bayamón hospital, authors of the study. Photo: Provided by the doctors to the Journal of Medicine and Public Health.
Liver abscess is an unusual suppurative focal process with moderate mortality (2-12%), according to the literature. The responsible pathogenic agents mainly belong to two groups, bacteria and parasites (Entamoeba histolytica), and give rise to two types of liver abscesses: pyogenic and amoebic, respectively.
While the pyogenic abscess is a bag of fluid filled with pus in the liver, the amoebic abscess is caused by Entamoeba histolytica, a parasite that causes amebiasis, an intestinal infection also called amoebic dysentery, where it can be transported through the bloodstream. blood from the intestines to the liver.
According to doctors María Cochran Pérez and Kattya Cruz, attached to the Bayamón hospital, pyogenic abscess is more common in the United States and affects more men between the fifth and eighth decade of life. They may have nonspecific symptoms such as diarrhea, nausea, vomiting, body and joint pain, headaches, and right-sided pleural effusions.
However, other late symptoms include fever, chills, abdominal pain, which may be localized to the right upper quadrant, and may be complicated by sepsis or spontaneous rupture in rare cases. Patients are at risk when they have had recent abdominal infections, recent hepatobiliary disease or surgery, dental infection, intravenous drug use, cancer, immunosuppression, among others.
Diagnosis can be made by an abdominopelvic CT study.
Precisely in Puerto Rico, an unusual case of a liver finding disguised as a diagnosis of gastritis was recorded in a 58-year-old patient. The patient had a history of diabetes, hypertension, hyperlipidemia, and gastroesophageal reflux.
“The patient reported that he had eaten a hamburger, and that following that his pain began in the epigastric area, which worsened,” added Dr. Cruz.
The patient was admitted to the hospital with a diagnosis of gastroenteritis, and due to the symptoms presented, an endoscopy was performed, which revealed that he had it.
A high fever began to affect the patient the same day of the procedure, and he presented septic shock. Blood cultures showed the growth of a bacterium, which was later revealed to be Escherichia coli, and also results of the metabolic panel showed that the levels of liver enzymes and alkaline phosphates were altered, they reported.
The patient was ordered an abdominopelvic sonogram, where the doctors might not perceive any clinical situation, although the patient already had kidney failure.
“We already had the situation of bacteremia due to E. coli and we saw that in the metabolic panel levels the liver enzymes were elevated, we decided to perform an abdominopelvic CT with contrast once the renal failure was resolved, to look for what we suspected, an abscess of the area of the liver and biliary system and an abscess formation or lobulated cyst was found that was in the liver, near the gallbladder,” Cruz explained.
“The patient was referred to interventional radiology so that the abscess was drained, and was sent for culture, which was also positive for (the bacteria) E. coli, thus finding the source of infection of the bacteremia,” he added.
The patient completed 14 days of antibiotics and was discharged from the hospital.
It is important to take this type of diagnosis into account because mortality is high if it is not diagnosed quickly. These abscesses are not common and that is why diagnosing them is difficult. For this reason, this case presents an opportunity to raise awareness regarding this type of scenario because these types of patients present with very varied symptoms that can lead doctors to misdiagnosis, emphasized Dr. Cochran.
See the exclusive presentation of this case here.