Asymptomatic presentation of giant liver abscess: simultaneous Klebsiella pneumoniae and amoebic infection in an immunocompetent comorbid patient
DOI:
https://doi.org/10.18203/2349-2902.isj20243244Keywords:
Asymptomatic liver abscess, Giant liver abscess, Amoebic liver abscess, Pyogenic hepatic abscess, Klebsiella pneumoniaeAbstract
Liver abscess is a rare clinical entity, giant abscess is also rare and asymptomatic presentation in immune competency is even rare. Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients, just few articles. Our case, a 69-year-old man was discovered to have hypoechoic liver mass during a scan of the abdomen for evaluation of dysuria. He was hospitalized through ER for advanced assessment. Systemic inquiries of the patient revealed generalized fatigue, constipation, but no fever, chills, abdominal pain or hypotension. Physical examination revealed normal liver span and no right upper quadrant tenderness. Tumor markers were not strikingly high and an enhanced abdominal computed tomography showed a large area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 220 ml of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 3 weeks on treatment with meropenem and metronidazole, along with sustained drainage of the abscess cavity. No parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. Giant size, possible coexistence of amoebae and bacteria in a liver abscess and asymptomatic presentation should not be discounted.
References
Friedman LS. Pyogenic hepatic abscess. Current Medical Diagnosis and Treatment. Papadakis MA, McPhee SJ, Rabow MW (ed): McGraw-Hill, New York. 2020. Available at: https://accessmedicine.mhmedical.com.
Mohanty S, Panigrahi MK, Turuk J, Dhal S. Liver abscess due to Streptococcus constellatus in an immunocompetent adult: a less known entity. J Natl Med Assoc. 2018;110:591-5.
Lin HF, Liao KF, Chang CM, Lin CL, Lai SW: Correlation between proton pump inhibitors and risk of pyogenic liver abscess. Eur J Clin Pharmacol. 2017;73:1019-25.
Riaz MF, Genao A, Omore I: Acute presentation of simultaneous liver abscesses caused by Streptococcus constellatus. Cureus. 2020;12:8497.
Dsouza R, Roopavathana B, Chase S, Nayak S. Streptococcus constellatus: a rare causative agent of pyogenic liver abscess. BMJ Case Rep. 2019;12:229738.
Akuzawa N, Hatori T, Kitahara Y, Kurabayashi M. Multiple liver abscesses and bacteremia caused by Streptococcus constellatus infection: a case report. Clin Case Rep. 2017;5:69-74.
Datta P, Mohi GK, Chander J, Attri AK: Streptococcus constellatus causing multiple liver abscesses: an elusive pathogen. Trop Doct. 2018;48:154-6.
Chen HL , Chang WH. Simultaneous Klebsiella pneumoniae and amoebic liver abscess in an immunocompetent patient. Am J Med Sci. 2008;335(5):379-81.
Agha RA, Borrelli MR, Farwana R. The SCARE 2018 state- ment: updating consensus surgical case report (SCARE) guide- lines. Int J Surg. 2018;60:132–6.
Mavilia MG, Molina M, Wu GY. The evolving nature of hepatic abscess: a review. J Clin Transl Hepatol. 2016;4:158–68.
Friedman LS. Current medical diagnosis and treatment. New York: McGraw-Hill. Pyogenic hepatic abscess. Cureus. 2021;13(8):17626.
Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol. 2005; 100(2):322-31.
The impact of obesity on the immune response to infection. Milner JJ, Beck MA. Proc Nutr Soc. 2012;71:298–306.
Chan KS, Chen CM, Cheng KC, Hou CC, Lin HJ. Pyogenic liver abscess: a retrospective analysis of 107 patients during a 3-year period Jpn J Infect Dis. 2005;58(6):336-66.
Xu S, Shi B, Chao LM. Prognostic normogram for the combination therapy of percutaneous catheter drainage and antibiotics in pyogenic liver abscess patients. Abdom Radiol (NY). 2020;45:393-402.
Herbert DA, Rothman JA, Simmons DA, Fogel S. Wilson, J. Ruskin Pyogenic liver abscesses: successful non-surgical therapy Lancet. 1982;319(8264):134-6.
Ralph ED. Successful antimicrobial therapy of hepatic, intra-abdominal and intrapelvic abscesses Can Med Assoc J. 1984;131(6):605-7.