A case of gas-forming pyogenic liver abscess]

A 62-year-old man with a 20-year history of diabetes mellitus presented with appetite loss was found and a large niveau was found in the right subphrenic space on abdominal X-ray film. Ultrasonography and computed tomography showed a large hepatic abscess with gas formation and cholecystitis with a gallstone. Klebsiella pneumoniae was isolated from the abscess, which communicated with the bile duct and was treated with antibiotics and percutaneous drainage. It should thus be noted that increased anaerobic catabolism by microbes and impaired transport of end products may cause gas-formation in patients with diabetes mellitus.     

A case of primary neuroendocrine carcinoma of liver presenting with liver abscess]

Primary hepatic neuroendocrine cell carcinoma is a very rare tumor. We experienced a 75-year-old woman with primary hepatic neuroendocrine carcinoma presenting with pyogenic liver abscess. Abdominal CT scan revealed a multiseptated liver abscess and an enlarged lymph node in portocaval portion. We performed percutaneous drainage of the liver abscess, but the amount of drained pus did not decrease after 20 days. The follow-up abdominal CT scan showed that the cystic portion of liver abscess had been replaced by the solid tumor. Microscopic examination of the tumor tissue showed nests of epithelial cells with uniform round hyperchromatic nuclei and high nuclear to cytoplasmic ratio. Immunohistochemical staining was strongly positive for synaptophysin and chromogranin A.     

A case of chronic empyema caused by Salmonella Livingstone with soft-tissue abscess]

A 65-year-old man with old tuberculous pleuritis was admitted to our hospital because of swelling and heat on the right upper abdomen on December 8, 2006. Computed tomography showed the presence of thickening and calcification of the right pleura, capsular effusion, and soft-tissue swelling of the right upper abdomen. Salmonella Livingstone was isolated from the aspiration specimen of the capsular effusion. Chronic empyema caused by Salmonella Livingstone with soft-tissue abscess was diagnosed, and was treated with 400 mg per day levofloxacin. Salmonella spp. is known as a common pathogen of gastroenteritis. Pleuropulmonary Salmonella infection is rare, and only 5 cases have been reported in Japan. However, this organism can cause respiratory tract infection in a patient with an impaired host defence system such as old tuberculosis.     

A case of malignant gastrointestinal stromal tumor of ileum with liver abscess]

Gastrointestinal stromal tumor (GIST) is an uncommon mesenchymal tumor of the gastrointestinal tract and is generally located in the stomach and small intestine. They usually present with abdominal pain, gastrointestinal bleeding, and palpable mass. Some patients present with rare symptoms that are more common in malignant GIST. Malignant GIST combined with a liver abscess has not been reported yet in the literatures. We report a case of 67-year-old woman who suffered from liver abscess combined by malignant GIST with central necrosis and fistula in the ileum. She complained of fever, chills, and abdominal pain. Abdominal CT scan showed huge liver abscess and ileal mass with air pocket. Small bowel series showed contrast material filling into the ileal GIST mass. An operation was performed and the final diagnosis was malignant GIST of the ileum with invasion into the sigmoid colon and urinary bladder.     

A case of empyema with subphrenic abscess]

A 75-year-old female was admitted to our hospital with complaints of fever, cough and left hypochondralgia. She had been operated for cholecystectomy ten years ago. Chest roentgenogram indicated bilateral pleural effusion. Tube drainage was done to the left thorax and empyema was caused by Bacteroides fragilis and Escherichia coli (E. coli). Though antibiotic therapy was already being conducted, the left hypochondralgia persisted. A CT scan and MRI demonstrated local subphrenic abscess around the spleen due to E. coli. Tube drainage was conducted to the subphrenic abscess under ultrasound control and and the symptoms disappeared rapidly. The present results show that examination of the abdomen is necessary for empyema with complication of compromised host. The past history of abdominal surgery and disturbance in the biliary tract should also be considered.     

A case of liver abscess caused by Edwardsiella tarda

Edwardsiella tarda, a member of the Enterobacteriaceae family, is found in freshwater and marine environments. Extraintestinal infections of Edwardsiella tarda have been rarely reported. We describe a 70-year-old Japanese woman suffering from autoimmune hemolytic anemia, with liver abscess caused by Edwardsiella tarda. She had a history of cholecystectomy for gallbladder stone 10 years prior to this admission. She was successfully treated with percutaneous transhepatic abscess aspiration and meropenem. This is the first report of liver abscess caused by Edwardsiella tarda in Japan.     

A case of gas-forming liver abscess with diabetes mellitus

A 43-year-old man was admitted to our hospital with right hypochondriac and epigastric pain. An abdominal radiograph showed a large niveau in the right subphrenic space. An abdominal CT scan demonstrated a large liver abscess (diameter, 13 cm) with gas formation. Klebsiella pneumoniae cells were isolated from the abscess, and the patient was treated with antibiotics and percutaneous drainage. It is very important to treat gas-forming liver abscess immediately, because subsequent bacteremia and septic shock are frequently noted, and the associated mortality rate is high.