BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to...BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.展开更多
BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage...BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.展开更多
BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocyto...BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocytogenes in apreviously healthy adult patient. The patient’s magnetic resonance imagingexamination showed multiple brain abscesses, and his second cerebrospinal fluidculture test indicated the presence of Listeria monocytogenes. Despite earlyempirical therapy, the patient’s condition progressively deteriorated. Because thepatient's abscesses were located in the brainstem and multiple lobes, surgery wasnot possible. The patient died 40 d after admission.CONCLUSIONThis case highlights the importance of rational clinical use of drugs to avoidpotentially serious infectious complications.展开更多
BACKGROUND Systemic lupus erythematosus(SLE)patients are extremely susceptible to opportunistic infections due to glucocorticoid and immunosuppressive treatments,which often occur in the respiratory system,the urinary...BACKGROUND Systemic lupus erythematosus(SLE)patients are extremely susceptible to opportunistic infections due to glucocorticoid and immunosuppressive treatments,which often occur in the respiratory system,the urinary system and the skin.However,multiple cerebral infections are rarely reported and their treatment is not standardized,especially when induced by a rare pathogen.CASE SUMMARY A 46-year-old woman was treated with glucocorticoid and immunosuppressant for SLE involving the hematologic system and kidneys(class IV-G lupus nephritis)for more than one year.She was admitted to hospital due to headache and fever,and was diagnosed with multiple cerebral abscesses.Brain enhanced magnetic resonance imaging showed multiple nodular abnormal signals in both frontal lobes,left parietal and temporal lobes,left masseteric space(left temporalis and masseter region).The initial surgical plan was only to remove the large abscesses in the left parietal lobe and right frontal lobe.After surgery,based on the drug susceptibility test results(a rare pathogen Nocardia asteroides was found)and taking into consideration the patient’s renal dysfunction,a multi-antibiotic regimen was selected for the treatment.The immunosuppressant mycophenolate mofetil was discontinued on admission and the dose of prednisone was reduced from 20 mg/d to 10 mg/d.Re-examination at 3 mo post-surgery showed that the intracranial lesions were reduced,the edema around the lesions was absorbed and dissipated,and her neurological symptoms had disappeared.The patient had no headaches or other neurological symptoms and lupus nephritis was stable during the 2-year follow-up period.CONCLUSION In this report,we provide reasonable indications for immunosuppression,anti-infective therapy and individualized surgery for an SLE patient complicated with multiple cerebral abscesses caused by a rare pathogen,which may help improve the diagnosis and treatment of similar cases.展开更多
Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patie...Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patients with DNA will be identified. Methods: We retrospectively studied 29 patients who presented to the department of otolaryngology with deep neck abscesses between April 2011 and April 2015. These 29 patients were managed with CPD after antibiotic therapy or needle aspiration failed. Data on patient demographics, location of infection, existing comorbidity, duration of hospitalization, treatment received, and complications were reviewed. Results: The average age of 29 patients, including 18 men and 11 women, was 56 years old. Abscess was found in parapharyngeal space (n = 16), submandibular space (n = 7), retropharyngeal space (n = 5) and pretracheal space (n = 1). The maximum transverse diameter of abscess ranged from 4.8 cm to 8.0 cm (mean 6.03 cm). Positive cultures were found in 24 cases and the most common pathogen found was Streptococcus viridans. Average hospital stay was 6.7 days. Deep neck abscesses were completely removed without residual in all patients. No one had complications and no one died during and after CPD. Conclusion: CPD is a safe and highly effective procedure for treating patients with deep neck abscesses who do not respond to antibiotics therapy. This technique can also provide reliable evidence on pathogens responsible for deep neck abscesses and help otolaryngologists choose effective treatment to achieve better clinical success rate. We recommend that most deep neck abscesses should be managed initially by CPD before resorting to open surgery.展开更多
Multiple abscesses of the costo-chondral junctions are very uncommon in practice.In this report we present the case of a 55 year old man who presented to us with chest pain and fever of few months duration.On imaging ...Multiple abscesses of the costo-chondral junctions are very uncommon in practice.In this report we present the case of a 55 year old man who presented to us with chest pain and fever of few months duration.On imaging with ultrasound and CECT we were able to demonstrate multiple abscesses of costo-chondral junctions bilaterally.We confirmed tuberculosis by FNAC and BACTEC cultures from abscesses.展开更多
BACKGROUND Burkholderia gladioli(B.gladioli)is regarded as a rare opportunistic pathogen.Only a few patients with abscesses caused by B.gladioli infections have been reported,and these are usually abscesses at the inc...BACKGROUND Burkholderia gladioli(B.gladioli)is regarded as a rare opportunistic pathogen.Only a few patients with abscesses caused by B.gladioli infections have been reported,and these are usually abscesses at the incision caused by traumatic surgery.CASE SUMMARY A 74-year-old male patient with abscesses and pain throughout his body for 1 mo was admitted to our hospital.Some of the abscesses had ruptured with purulent secretions on admission.Color Doppler ultrasound examination of the body surface masses showed mixed masses 75 mm×19 mm,58 mm×17 mm,17 mm×7 mm,and 33 mm×17 mm in size in the muscle tissues of both the right and left forearms,the posterior area of the right knee and the left leg,respectively.Abscess secretions and blood cultures grew B.gladioli.The following 3 methods were used to jointly identify the bacterium:an automatic microbial identification system,matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,and full-length 16 S rDNA sequencing.After 27 d of treatment with meropenem,etimicin,trimethoprim-sulfamethoxazole and other antibiotics,most of his skin abscesses were flat and he was discharged without any symptoms.CONCLUSION This is the first reported case of multiple skin abscesses associated with bacteremia caused by B.gladioli.Our study provides important reference values for the clinical diagnosis and treatment of B.gladioli infections.展开更多
We previously demonstrated that brief nonkilling neutrophil exposure diminishes the binding affinity of S. aureus penicillin-binding protein (PBP) 2. We sought to investigate further the role of the neutrophil in the ...We previously demonstrated that brief nonkilling neutrophil exposure diminishes the binding affinity of S. aureus penicillin-binding protein (PBP) 2. We sought to investigate further the role of the neutrophil in the alteration of antimicrobial activity and its interaction with PBP-2 by studying the activity of cefotaxime, which highly binds to PBP 2, and cephalexin, which minimally binds to PBP 2. Using S. aureus, cultured in vitro in sterile-filtered normal and neutrophil depleted abscess fluid, we sought to demonstrate an in vivo significance of the neutrophil effect upon the activity of antimicrobials that target PBP-2 by studying the same antimicrobials in an experimental S. aureus abscess. Rats were implanted with perforated tissue cages and infected with S. aureus;some rats were neutrophil depleted by mechlorethamine. Abscess fluids from normal and neutropenic abscesses were harvested, pooled, sterile-filtered and stored for the time-kill studies. Treatment studies were performed by administering either 300 μg/kg/d cefotaxime or cephalexin for 7 days in other rats with 24 hour-old tissue-cage S. aureus abscesses. In time-kill studies, cefotaxime was highly active against stationary phase S. aureus in MHB and in neutropenic abscess fluid, but less active in the non-neutropenic abscess fluid (p 10 kill, p = 0.029 vs. 0.81 ± 2.5, p = NS). These data suggest that neutrophil exposure, which diminishes S. aureus PBP-2 binding affinity [or total quantity], also adversely affects the antimicrobial activity of cefotaxime, which binds to PBP-2, as compared to cephalexin. Altered PBP targets from neutrophil exposure may be a mechanism of antimicrobial resistance within abscesses.展开更多
Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impa...Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin’s gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin’s gland cysts and abscesses in FETHA. We studied all cases of Bartholin’s gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1<sup>st</sup> January 2012 to 31<sup>st</sup> December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin’s gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin’s gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin’s gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.展开更多
Objective To investigate the effective treatment of abscesses in thalanmus. Methods 3 patients with solitary abscess in thalamus are analyzed retrospectively, who were treated from Sep. 2009 to Jul. 2010. There were o...Objective To investigate the effective treatment of abscesses in thalanmus. Methods 3 patients with solitary abscess in thalamus are analyzed retrospectively, who were treated from Sep. 2009 to Jul. 2010. There were one male and two female patients. One patient treated with stereotactic展开更多
AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to ...AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.展开更多
AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a flui...AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. RESULTS: Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collections. The cyst size ranged between 28 cm × 13 cm and 5 cm × 5 cm. The EUS drainage was successful in 94% of the pseudocysts and in 80% of the abscesses (P = 0.04). The complication rate in pseudocysts was 6% and in abscesses was 30% (P = 0.02). Recurrence of a pseudocyst occurred in one patient (4%) after 6 mo; the patient was successfully retreated. CONCLUSION: EUS-guided drainage of pseudocysts is associated with a higher success rate and a lower complication rate compared with abscess drainage.展开更多
Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of ...Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.展开更多
Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The ...Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The latter are more common in the presence of a different primary site of infection, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Moreover, immunosuppression is a major risk factor. Clinical examination usually reveals a combination of fever, left-upper-quadrant abdominal pain and vomiting. Laboratory findings are not constant. Imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. Treatment includes conservative measures, and surgical intervention. In children and in cases of solitary abscesses with a thick wall, percutaneous catheter drainage may be attempted. Otherwise, splenectomy is the preferred approach in most centers. Here, we present three cases of splenic abscess. In all three, splenectomy was performed, followed by rapid clinical improvement. These cases emphasize that current understanding of spleen abscess etiology is still limited, and a study for additional risk factors may be necessary.展开更多
BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europ...BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.展开更多
Pelvic abscesses are usually the end stage in the progression of an infection.They may occur from surgical complications,generalized abdominal infections such as appendicitis or diverticulitis,or from localized infect...Pelvic abscesses are usually the end stage in the progression of an infection.They may occur from surgical complications,generalized abdominal infections such as appendicitis or diverticulitis,or from localized infections such as pelvic inflammatory disease or inflammatory bowel disease.Although surgery has been considered as the treatment of choice by some authors,pelvic abscesses can be managed by non-invasive methods such as ultrasound and computed tomography-guided drainage.The development of therapeutic linear echoendoscopes has allowed the endoscopist to perform therapeutic procedures.Recently,endoscopic ultrasonography(EUS)-guided drainage of pelvic collections has been demonstrated to be feasible,efficient and safe.It allows the endoscopist to insert stents and drainage catheters into the abscess cavity which drains through the large bowel.This article reviews technique, current results and future prospects of EUS-guided drainage of pelvic lesions.展开更多
AIM： To elucidate the clinical, radiological and laboratory pro？les of renal abscess （RA） and perinephric abscess （PNA）, along with related treatment and outcome.METHODS： Ninety-eight patients diagnosed with RA...AIM： To elucidate the clinical, radiological and laboratory pro？les of renal abscess （RA） and perinephric abscess （PNA）, along with related treatment and outcome.METHODS： Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi？ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition （ICD-10） codes （RA： N15.101, PNA： N15.102） between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro？les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS： The mean age of the patients was 46.49 years with a male to female ratio of 41：57. Lumbar pain （76.5%） and fever （53.1%） were the most common symptoms. Other symptoms and signs included chills （28.6%）, anorexia and vomiting （25.5%）, lethargy （10.2%）, abdominal pain （11.2%）, fank mass （12.2%）, fank ？stula （2.0%）, gross hematuria （7.1%）, frequency （14.3%）, dysuria （9.2%）, pyuria （5.1%） and weight loss （1.0%）. Painful percussion of the costovertebral angle （87.8%） was the most common physical ？nding. The main predisposing factors were lithiasis （48.0%）, diabetes mellitus （33.7%） followed by history of urological surgery （16.3%）, urinary tract infections （14.3%）, renal function impairment （13.3%）, liver cirrhosis （2.0%）, neurogenic bladder （1.0%）, renal cyst （1.0%）, hydronephrosis （1.0%）, chronic hepatitis B （1.0%）, post-discectomy （1.0%） and post-colectomy （1.0%）. Ultrasound （US） and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli （51.4%）, Staphylococcus aureus （10.0%） and Klebsiella pneumoniae （8.6%） were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION： Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.展开更多
Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are...Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.展开更多
BACKGROUND: Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography(CECT). The present study was to explore the usefulness of the analysis of multislice-...BACKGROUND: Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography(CECT). The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS: This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter(5 filter levels with sigma weighting ranging from 1.0 to 2.5). We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference(HSD) test. Diagnostic performance was evaluated using the receiver operating characteristic(ROC) curve analysis.RESULTS: There were significant differences in entropy and uniformity at all sigma weightings(P〈0.001) among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings(P=0.002-0.006). Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers(P=0.000-0.004). Entropy(at a sigma 2.0 weighting) had the largest area under the ROC curve(0.888) in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION: Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.展开更多
We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case,...We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.展开更多
文摘BACKGROUND Liver cirrhosis patients can develop various complications including bacteremia as the intestinal flora is heterologous.In those with low immunity,trauma,or following surgery,etc.,the body is susceptible to concurrent systemic or local infections.Under these circumstances,even minimally invasive treatment methods such as interventional therapy like transjugular intrahepatic portosystemic shunt(TIPS)for liver cirrhosis patients can also result in complications such as infections.CASE SUMMARY A male patient with decompensated cirrhosis experienced multiple episodes of gastrointestinal bleeding and hypersplenism.He was admitted to hospital due to voluntary remedial TIPS.The patient developed a numerous intrahepatic liver abscess postoperatively.Following initial conservative treatment with intravenous antibiotics and parenteral nutrition,three months after TIPS,the liver abscess had disappeared on imaging examination.At the 6-month postoperative follow-up,outpatient re-examination showed that the patient had recovered and the liver abscess had resolved.CONCLUSION Attention should be paid to decreased blood cell counts,especially low leukocyte levels in patients with liver cirrhosis as the presence of intestinal microbiota dysregulation and portal pyemia can result in liver abscess and sepsis during invasive diagnostic and therapeutic procedures like TIPS.The addition of probiotics might reduce the risk in such patients.
文摘BACKGROUND Non-liquefied multiple liver abscesses(NMLA)can induce sepsis,septic shock,sepsis-associated kidney injury(SA-AKI),and multiple organ failure.The inability to perform ultrasound-guided puncture and drainage to eradicate the primary disease may allow for the persistence of bacterial endotoxins and endogenous cytokines,exacerbating organ damage,and potentially causing immunosuppression and T-cell exhaustion.Therefore,the search for additional effective treatments that complement antibiotic therapy is of great importance.CASE SUMMARY A 45-year-old critically ill female patient presented to our hospital’s intensive care unit with intermittent vomiting,diarrhea,and decreased urine output.The patient exhibited a temperature of 37.8℃.Based on the results of liver ultrasonography,laboratory tests,fever,and oliguria,the patient was diagnosed with NMLA,sepsis,SA-AKI,and immunosuppression.We administered antibiotic therapy,entire care,continuous renal replacement therapy(CRRT)with an M100 hemofilter,and hemoperfusion(HP)with an HA380 hemofilter.The aforementioned treatment resulted in a substantial reduction in disease severity scores and a decrease in the extent of infection and inflammatory factors.In addition,the treatment stimulated the expansion of the cluster of differentiation 8^(+)(CD8^(+))Tcells and led to the complete recovery of renal function.The patient was discharged from the hospital.During the follow-up period of 28 d,she recovered successfully.CONCLUSION Based on the entire therapeutic regimen,the early combination of CRRT and HP therapy may control sepsis caused by NMLA and help control infections,reduce inflammatory responses,and improve CD8^(+)T-cell immune function.
文摘BACKGROUNDIntracranial Listeria infections are common in newborns and immunocompromisedindividuals, but brainstem abscesses are rare.CASE SUMMARYWe report a rare case of brainstem abscesses caused by Listeria monocytogenes in apreviously healthy adult patient. The patient’s magnetic resonance imagingexamination showed multiple brain abscesses, and his second cerebrospinal fluidculture test indicated the presence of Listeria monocytogenes. Despite earlyempirical therapy, the patient’s condition progressively deteriorated. Because thepatient's abscesses were located in the brainstem and multiple lobes, surgery wasnot possible. The patient died 40 d after admission.CONCLUSIONThis case highlights the importance of rational clinical use of drugs to avoidpotentially serious infectious complications.
文摘BACKGROUND Systemic lupus erythematosus(SLE)patients are extremely susceptible to opportunistic infections due to glucocorticoid and immunosuppressive treatments,which often occur in the respiratory system,the urinary system and the skin.However,multiple cerebral infections are rarely reported and their treatment is not standardized,especially when induced by a rare pathogen.CASE SUMMARY A 46-year-old woman was treated with glucocorticoid and immunosuppressant for SLE involving the hematologic system and kidneys(class IV-G lupus nephritis)for more than one year.She was admitted to hospital due to headache and fever,and was diagnosed with multiple cerebral abscesses.Brain enhanced magnetic resonance imaging showed multiple nodular abnormal signals in both frontal lobes,left parietal and temporal lobes,left masseteric space(left temporalis and masseter region).The initial surgical plan was only to remove the large abscesses in the left parietal lobe and right frontal lobe.After surgery,based on the drug susceptibility test results(a rare pathogen Nocardia asteroides was found)and taking into consideration the patient’s renal dysfunction,a multi-antibiotic regimen was selected for the treatment.The immunosuppressant mycophenolate mofetil was discontinued on admission and the dose of prednisone was reduced from 20 mg/d to 10 mg/d.Re-examination at 3 mo post-surgery showed that the intracranial lesions were reduced,the edema around the lesions was absorbed and dissipated,and her neurological symptoms had disappeared.The patient had no headaches or other neurological symptoms and lupus nephritis was stable during the 2-year follow-up period.CONCLUSION In this report,we provide reasonable indications for immunosuppression,anti-infective therapy and individualized surgery for an SLE patient complicated with multiple cerebral abscesses caused by a rare pathogen,which may help improve the diagnosis and treatment of similar cases.
文摘Objective: The purpose of this study is to evaluate the effectiveness and safety of CT-guided percutaneous drainage (CPD) in the management of deep neck abscesses. Factors associated with successful treatment in patients with DNA will be identified. Methods: We retrospectively studied 29 patients who presented to the department of otolaryngology with deep neck abscesses between April 2011 and April 2015. These 29 patients were managed with CPD after antibiotic therapy or needle aspiration failed. Data on patient demographics, location of infection, existing comorbidity, duration of hospitalization, treatment received, and complications were reviewed. Results: The average age of 29 patients, including 18 men and 11 women, was 56 years old. Abscess was found in parapharyngeal space (n = 16), submandibular space (n = 7), retropharyngeal space (n = 5) and pretracheal space (n = 1). The maximum transverse diameter of abscess ranged from 4.8 cm to 8.0 cm (mean 6.03 cm). Positive cultures were found in 24 cases and the most common pathogen found was Streptococcus viridans. Average hospital stay was 6.7 days. Deep neck abscesses were completely removed without residual in all patients. No one had complications and no one died during and after CPD. Conclusion: CPD is a safe and highly effective procedure for treating patients with deep neck abscesses who do not respond to antibiotics therapy. This technique can also provide reliable evidence on pathogens responsible for deep neck abscesses and help otolaryngologists choose effective treatment to achieve better clinical success rate. We recommend that most deep neck abscesses should be managed initially by CPD before resorting to open surgery.
文摘Multiple abscesses of the costo-chondral junctions are very uncommon in practice.In this report we present the case of a 55 year old man who presented to us with chest pain and fever of few months duration.On imaging with ultrasound and CECT we were able to demonstrate multiple abscesses of costo-chondral junctions bilaterally.We confirmed tuberculosis by FNAC and BACTEC cultures from abscesses.
基金Supported by Jilin Science and Technology Development Program,No.20190304110YY
文摘BACKGROUND Burkholderia gladioli(B.gladioli)is regarded as a rare opportunistic pathogen.Only a few patients with abscesses caused by B.gladioli infections have been reported,and these are usually abscesses at the incision caused by traumatic surgery.CASE SUMMARY A 74-year-old male patient with abscesses and pain throughout his body for 1 mo was admitted to our hospital.Some of the abscesses had ruptured with purulent secretions on admission.Color Doppler ultrasound examination of the body surface masses showed mixed masses 75 mm×19 mm,58 mm×17 mm,17 mm×7 mm,and 33 mm×17 mm in size in the muscle tissues of both the right and left forearms,the posterior area of the right knee and the left leg,respectively.Abscess secretions and blood cultures grew B.gladioli.The following 3 methods were used to jointly identify the bacterium:an automatic microbial identification system,matrix-assisted laser desorption/ionization time-of-flight mass spectrometry,and full-length 16 S rDNA sequencing.After 27 d of treatment with meropenem,etimicin,trimethoprim-sulfamethoxazole and other antibiotics,most of his skin abscesses were flat and he was discharged without any symptoms.CONCLUSION This is the first reported case of multiple skin abscesses associated with bacteremia caused by B.gladioli.Our study provides important reference values for the clinical diagnosis and treatment of B.gladioli infections.
文摘We previously demonstrated that brief nonkilling neutrophil exposure diminishes the binding affinity of S. aureus penicillin-binding protein (PBP) 2. We sought to investigate further the role of the neutrophil in the alteration of antimicrobial activity and its interaction with PBP-2 by studying the activity of cefotaxime, which highly binds to PBP 2, and cephalexin, which minimally binds to PBP 2. Using S. aureus, cultured in vitro in sterile-filtered normal and neutrophil depleted abscess fluid, we sought to demonstrate an in vivo significance of the neutrophil effect upon the activity of antimicrobials that target PBP-2 by studying the same antimicrobials in an experimental S. aureus abscess. Rats were implanted with perforated tissue cages and infected with S. aureus;some rats were neutrophil depleted by mechlorethamine. Abscess fluids from normal and neutropenic abscesses were harvested, pooled, sterile-filtered and stored for the time-kill studies. Treatment studies were performed by administering either 300 μg/kg/d cefotaxime or cephalexin for 7 days in other rats with 24 hour-old tissue-cage S. aureus abscesses. In time-kill studies, cefotaxime was highly active against stationary phase S. aureus in MHB and in neutropenic abscess fluid, but less active in the non-neutropenic abscess fluid (p 10 kill, p = 0.029 vs. 0.81 ± 2.5, p = NS). These data suggest that neutrophil exposure, which diminishes S. aureus PBP-2 binding affinity [or total quantity], also adversely affects the antimicrobial activity of cefotaxime, which binds to PBP-2, as compared to cephalexin. Altered PBP targets from neutrophil exposure may be a mechanism of antimicrobial resistance within abscesses.
文摘Background: The Bartholin’s gland cysts and abscesses are one of the most common vulva cyst or abscesses in gynaecological practice. Symptomatic cases give significant discomfort to sufferers and have a negative impact on their quality of life. Objective: To investigate the incidence, pattern of presentation and management of Barthholin’s gland cysts and abscesses in the Federal Teaching Hospital Abakaliki (FETHA) Ebonyi State, Nigeria. Methodology: This was a four-year retrospective study of cases of Bartholin’s gland cysts and abscesses in FETHA. We studied all cases of Bartholin’s gland cysts and abscesses that were managed at the Federal Teaching Hospital Abakaliki from 1<sup>st</sup> January 2012 to 31<sup>st</sup> December 2015. Results: During the study period, there were 1015 gynaecological surgical cases of which 18 were for Bartholin’s gland cysts or abscess giving an incidence of 1.78%. The mean age of the patients was 28.8 ± 5.6 years with 61% of the patients within the age range of 21 to 30 years. The commonest risk factor that was found for the occurrence of Bartholin’s gland cyst or abscess was previous history of the disease in 14 (77.8%) followed by previous history of sexually transmitted diseases 8 (44.4%). Pain was the commonest presenting symptom in 14 (77.8%) of cases. The left vulva was the commonest site of disease as noted in 15 (83.3%) of patients. Escherichia coli and Staphylococcus aureus were the commonest isolates on swabs with 16 (88.9%) and 14 (77.8%) prevalence respectively. The disease presented commonly in form of abscess as observed in 10 (55.6%) of patients. All the patients had Marsupialization as the modality of treatment. Conclusion: Symptomatic Bartholin’s gland cyst and abscess cause significant morbidity for the sufferers and decreased quality of life. Accurate diagnosis and treatment is advocated to prevent chronicity and complications. Although options of treatment abound, Marsupialization remains the mainstay of treatment in low resource setting like ours.
文摘Objective To investigate the effective treatment of abscesses in thalanmus. Methods 3 patients with solitary abscess in thalamus are analyzed retrospectively, who were treated from Sep. 2009 to Jul. 2010. There were one male and two female patients. One patient treated with stereotactic
基金Supported by The National Natural Science Foundation of China, No. 30872482 and No. 81072051
文摘AIM: To elaborate the clinicopathologic features of colorectal cancer-related pyogenic liver abscess (PLA). METHODS: Reported cases of colorectal cancer-related PLAs were collected from the literature published up to October 2011 and evaluated for their clinicopathologic features. Data of collected cases included demographics, clinical presentation, microbial findings and treatment. Categorical variables were compared by 2 analysis and continuous variables were evaluated using Student's t test. RESULTS: A total 96 cases of colorectal cancer-related PLA were collected from the previous literature. Most patients (60%) were male and 40% cases occurred in the age group of 61-70 years. Apart from some special types of PLA, there were significant differences in the microbiological spectrum between Eastern Asia and non-Eastern Asian countries, which implied different risk factors and courses of the disease. Gram negative bacteria especially Klebsiella pneumoniae (K. pneu- moniae ) PLA was predominant in Eastern Asia (80.0%) in contrast to non-Eastern Asian countries (P < 0.01). Meanwhile, most of the Eastern Asian patients exhibited smaller size of liver abscess and atypical presentation. Sigmoid colon and rectum (72.73%) were the main sites of tumor in Eastern Asian patients, whereas tumor sites were uneven among most of the non-Easter Asian PLA patients. CONCLUSION:K. pneumoniae PLA was strongly associated with colorectal cancer, especially those occurring in sigmoid colon and rectum, in elderly Eastern Asian male patients.
基金Supported by The Health and Medical Care Executive Board of the Vstra Gtaland Region, Sweden
文摘AIM: To compare the results for endoscopic ultrasound (EUS)-guided drainage of clear fluid pancreatic pseudocysts with the results for abscess drainage. METHODS: All patients referred for endoscopic drainage of a fluid collection were prospectively included. The outcome was recorded. RESULTS: Altogether 26 pseudocysts or abscesses were treated in 25 (6 female) patients. One endoscopist performed the procedures. Non-infected pseudocysts were present in 15 patients and 10 patients had infected fluid collections. The cyst size ranged between 28 cm × 13 cm and 5 cm × 5 cm. The EUS drainage was successful in 94% of the pseudocysts and in 80% of the abscesses (P = 0.04). The complication rate in pseudocysts was 6% and in abscesses was 30% (P = 0.02). Recurrence of a pseudocyst occurred in one patient (4%) after 6 mo; the patient was successfully retreated. CONCLUSION: EUS-guided drainage of pseudocysts is associated with a higher success rate and a lower complication rate compared with abscess drainage.
文摘Although endoscopic ultrasound(EUS)-guided drainage has become the standard procedure for pancreatic pseudocysts in recent years and is generally regarded as a safe and effective method,there have been few reports of EUS-guided drainage of postoperative intra-abdominal abscesses.Here we report our experience with 4 cases of postoperative intraabdominal abscesses for which EUS-guided drainage was performed between May 2011 and May 2014.Distal pancreatectomy had been performed in 3 cases,whereas low anterior resection for rectal cancer was performed in the remaining case.All patients underwent transgastric naso-cystic drainage,which resulted in clinical improvement without complications,even when performed within 4 wk after surgery.On average,the naso-cystic drain was removed 10 d after placement,with no abscess recurrence.Based on these findings,we believe that EUS-guided drainage of postoperative intraabdominal abscesses is a safe and effective method,although further large-scale investigations are required to confirm our findings.
文摘Abscess of the spleen is a rare discovery, with about 600 cases in the international literature so far. Although it may have various causes, it is most usually associated with trauma and infections of the spleen. The latter are more common in the presence of a different primary site of infection, especially endocarditis or in cases of ischemic infarcts that are secondarily infected. Moreover, immunosuppression is a major risk factor. Clinical examination usually reveals a combination of fever, left-upper-quadrant abdominal pain and vomiting. Laboratory findings are not constant. Imaging is a necessary tool for establishing the diagnosis, with a choice between ultrasound and computed tomography. Treatment includes conservative measures, and surgical intervention. In children and in cases of solitary abscesses with a thick wall, percutaneous catheter drainage may be attempted. Otherwise, splenectomy is the preferred approach in most centers. Here, we present three cases of splenic abscess. In all three, splenectomy was performed, followed by rapid clinical improvement. These cases emphasize that current understanding of spleen abscess etiology is still limited, and a study for additional risk factors may be necessary.
文摘BACKGROUND Pyogenic liver abscess(PLA)is a rare disease with an estimated incidence that varies widely across the globe,being as high as 115.4/100000 habitants in Taiwan and as low as 1.1-1.2/100000 habitants in Europe and Canada.Even though there are multiple microorganisms capable of producing an abscess in the liver,including Entamoeba histolytica,fungi,and viruses,most abscesses are derived from bacterial infections.The epidemiology of PLA in Mexico is currently unknown.AIM To describe the clinical,demographic and microbiologic characteristics of PLA in Mexico.METHODS This is a retrospective study carried out in two centers,and included patients seen between 2006 and 2018 with the diagnosis of pyogenic abscess.We collected demographic,clinical,and microbiological information,treatment,complications,and outcomes.A logistic regression analysis was used to determine the association between different variables and mortality rates.RESULTS A total of 345 patients were included in this study.233(67.5%)had confirmed PLA,133(30%)patients had no positive culture and negative serology and 9(2.5%)had mixed abscesses.The mean age was 50 years(ranging from 16-97 years)and 63%were female.65%of the patients had positive cultures for Extended Spectrum Beta-Lactamases(ESBL)-Escherichia coli and Klebsiella pneumoniae.Cefotaxime was administered in 60%of cases.The most common sources of infection were ascending cholangitis and cholecystitis in 34(10%)and 31(9%),respectively.The median length of hospital stay was 14 d.165 patients underwent percutaneous catheter drainage.The inpatient mortality rate was 63%.Immunocompromised state[OR 3.9,95%CI:1.42-10.46],ESBL-Escherichia coli[OR 6.7,95%CI:2.7-16.2]and Klebsiella pneumoniae[OR 4-8,95%CI:1.6-14.4]predicted inpatient mortality by multivariate analysis.CONCLUSION The prevalence of PLA is increasing in Mexico and has a very high mortality rate.ESBL-Escherichia coli and Klebsiella pneumoniae are the most common microorganisms causing PLA and are independent predictors of inpatient mortality.
文摘Pelvic abscesses are usually the end stage in the progression of an infection.They may occur from surgical complications,generalized abdominal infections such as appendicitis or diverticulitis,or from localized infections such as pelvic inflammatory disease or inflammatory bowel disease.Although surgery has been considered as the treatment of choice by some authors,pelvic abscesses can be managed by non-invasive methods such as ultrasound and computed tomography-guided drainage.The development of therapeutic linear echoendoscopes has allowed the endoscopist to perform therapeutic procedures.Recently,endoscopic ultrasonography(EUS)-guided drainage of pelvic collections has been demonstrated to be feasible,efficient and safe.It allows the endoscopist to insert stents and drainage catheters into the abscess cavity which drains through the large bowel.This article reviews technique, current results and future prospects of EUS-guided drainage of pelvic lesions.
文摘AIM： To elucidate the clinical, radiological and laboratory pro？les of renal abscess （RA） and perinephric abscess （PNA）, along with related treatment and outcome.METHODS： Ninety-eight patients diagnosed with RA or PNA using the primary discharge diagnoses identi？ed from the International Statistical Classification of Diseases and Related Health Problems Tenth Edition （ICD-10） codes （RA： N15.101, PNA： N15.102） between September 2004 and December 2014 in West China Hospital were selected. Medical records including patients’ characteristics, symptoms and signs, high-risk factors, radiological features, causative microorganisms and antibiotic-resistance pro？les, treatment approaches, and clinical outcomes were collected and analyzed.RESULTS： The mean age of the patients was 46.49 years with a male to female ratio of 41：57. Lumbar pain （76.5%） and fever （53.1%） were the most common symptoms. Other symptoms and signs included chills （28.6%）, anorexia and vomiting （25.5%）, lethargy （10.2%）, abdominal pain （11.2%）, fank mass （12.2%）, fank ？stula （2.0%）, gross hematuria （7.1%）, frequency （14.3%）, dysuria （9.2%）, pyuria （5.1%） and weight loss （1.0%）. Painful percussion of the costovertebral angle （87.8%） was the most common physical ？nding. The main predisposing factors were lithiasis （48.0%）, diabetes mellitus （33.7%） followed by history of urological surgery （16.3%）, urinary tract infections （14.3%）, renal function impairment （13.3%）, liver cirrhosis （2.0%）, neurogenic bladder （1.0%）, renal cyst （1.0%）, hydronephrosis （1.0%）, chronic hepatitis B （1.0%）, post-discectomy （1.0%） and post-colectomy （1.0%）. Ultrasound （US） and computed tomography were the most valuable diagnostic tools and US was recommended as the initial diagnostic imaging choice.Escherichia coli （51.4%）, Staphylococcus aureus （10.0%） and Klebsiella pneumoniae （8.6%） were the main causative microorganisms. Intravenous antibiotic therapy was necessary while intervention including surgical and nonsurgical approaches were reserved for larger abscesses, multiple abscesses, PNAs and non-responders. CONCLUSION： Heightened alertness, prompt diagnosis, and especially proper antibiotics in conjunction with interventional approaches allow a promising clinical outcome of renal and perinephric abscesses.
文摘Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease,especially in Crohn's disease,and in other diseases.However,aseptic abscesses associated with Beh et's disease are extremely rare.We report a Japanese male diagnosed with an incomplete type of Beh et's disease who developed multiple aseptic abscesses of the spleen and liver.In 2002,the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum.As the patient's response to antibiotic treatment was inadequate,a splenectomy was performed.Severe inflammatory cell infiltration,largely of polymorphonuclear neutrophils,was observed without evidence of bacterial or fungal growth.Although the patient had no history of ocular symptoms or genital ulcers,a diagnosis of incomplete Beh et's disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002.In 2005,multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Beh et's disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy.Oral prednisone(15 mg/d) was started in May 2006,and the abscesses dramatically disappeared 4 wk after treatment.Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone,the augmentation of prednisone dosage yielded a response.The abscesses of the liver and spleen were strongly suggested to be attributed to Beh et's disease.Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Beh et's disease.
基金supported by grants from Medical Engineering Cross Research Foundation of Shanghai Jiaotong University(YG2013MS37 and YG2012MS16)the National Natural Science Foundation of China(81201172,81371660 and 81371622)
文摘BACKGROUND: Pyogenic hepatic abscess may mimic primary or secondary carcinoma of the liver on contrast-enhanced computed tomography(CECT). The present study was to explore the usefulness of the analysis of multislice-based texture acquired from CECT in the differentiation between pyogenic hepatic abscesses and malignant mimickers.METHODS: This retrospective study included 25 abscesses in 20 patients and 33 tumors in 26 subjects who underwent CECT. To make comparison, we also enrolled 19 patients with hepatic single simple cyst. The images from CECT were analyzed using a Laplacian of Gaussian band-pass filter(5 filter levels with sigma weighting ranging from 1.0 to 2.5). We also quantified the uniformity, entropy, kurtosis and skewness of the multislice-based texture at different sigma weightings. Statistical significance for these parameters was tested with oneway ANOVA followed by Tukey honestly significant difference(HSD) test. Diagnostic performance was evaluated using the receiver operating characteristic(ROC) curve analysis.RESULTS: There were significant differences in entropy and uniformity at all sigma weightings(P〈0.001) among hepatic abscesses, malignant mimickers and simple cysts. The significant difference in kurtosis and skewness was shown at sigma 1.8 and 2.0 weightings(P=0.002-0.006). Tukey HSD testshowed that the abscesses had a significantly higher entropy and lower uniformity compared with malignant mimickers(P=0.000-0.004). Entropy(at a sigma 2.0 weighting) had the largest area under the ROC curve(0.888) in differentiating abscesses from malignant mimickers, with a sensitivity of 81.8% and a specificity of 88.0% when the cutoff value was set to 3.64.CONCLUSION: Multislice-based texture analysis may be useful for differentiating pyogenic hepatic abscesses from malignant mimickers.
文摘We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.
