Fungal hepatic abscesses: characterization and management

Hepatic abscesses are being recognized with increasing frequency in immunocompromised patients and those with malignant diseases. Risk factors and treatment for patients with pure fungal abscesses and mixed fungal and pyogenic abscesses have not been well described. A retrospective review of patients with hepatic abscesses was undertaken at The Johns Hopkins Hospital from 1973 through 1993. Eight patients with pure fungal hepatic abscesses and 34 patients with mixed fungal/pyogenic abscesses were identified. Clinical presentation, diagnosis, management, and outcome were analyzed. In the group with pure fungal abscesses, fungemia was predictive of death; four patients in this group died, whereas the remaining four patients who received amphotericin B treatment before the onset of fungemia all survived. In the group with mixed fungal/pyogenic abscesses, 11 patients received amphotericin B, whereas 23 did not. Ten (43%) of these 23 patients died. However, only one of five patients who received more than 1000 mg of amphotericin B died. In patients with hematologic malignancies, who are known to be at risk for fungal infections, amphotericin B treatment should be instituted early. In patients with mixed fungal/pyogenic hepatic abscesses who fail to improve after drainage and broad-spectrum antibiotics, antimycotic therapy should be considered early, before the onset of fungemia.