Here we present a case of pyogenic liver abscess caused by S anginosus in an adolescent presenting with fever, nausea, emesis, and right upper quadrant abdominal discomfort. [ncbi.nlm.nih.gov]

• Fever

  Patients with pyogenic liver abscesses often present to the emergency department with fever of unknown origin. [ncbi.nlm.nih.gov]

  Fever Lethargy Discomfort in right upper quadrant of abdomen Anorexia Enlarged and tender liver Pleural effusion Fever Abdominal discomfort Enlarged liver Biliary disease (most common)E.g.: stones, cholangiocarcinoma Colonic diseaseE.g.: diverticulitis [en.wikipedia.org]

• Pediatric Disease

  Pyogenic liver abscess (PLA) is a rare pediatric disease. Typically, PLA is found in adults with biliary disease. There are no typical physical findings or symptoms. Often, pathogenic organisms are not recovered for identification. [ncbi.nlm.nih.gov]

• Pseudotumor

  Two patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular carcinoma. One patient underwent hepatic resection with good results. [ncbi.nlm.nih.gov]

• Respiratory Distress

  Compared with the survivor group, patients in the mortality group were characterized by male gender (p 0.001), malignancy (p 0.001), respiratory distress (p 0.007), low blood pressure (p 0.024), jaundice (p 0.001), rupture of liver abscess (p 0.001), [ncbi.nlm.nih.gov]

  The patient was empirically started on intravenous vancomycin, monocef and metronidazole, but patient's condition deteriorated further with the development of features of respiratory distress. [ijpmonline.org]

• Abdominal Pain

  Their most common symptoms were fever and abdominal pain. Eight (53.0%) had leukocytosis ( 15000/μL) and elevated C-reactive protein (CRP) level ( 10 mg/dL). [ncbi.nlm.nih.gov]

• Bilious Vomiting

  During hospital stay he developed intermittent large quantity bilious vomiting. Gastroduodenoscopy and contrast-enhanced CT of the abdomen showed rupture of left lobe liver abscess into the stomach. [ncbi.nlm.nih.gov]

• Jaundice

  Compared with the survivor group, patients in the mortality group were characterized by male gender (p 0.001), malignancy (p 0.001), respiratory distress (p 0.007), low blood pressure (p 0.024), jaundice (p 0.001), rupture of liver abscess (p 0.001), [ncbi.nlm.nih.gov]

  Chest pain (lower right) Pain in the right upper abdomen (more common) or throughout the abdomen (less common) Clay-colored stools Dark urine Fever, chills, nightsweats Loss of appetite Nausea, vomiting Unintentional weight loss Weakness Yellow skin ( jaundice [nlm.nih.gov]

  Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. [hepatitiscentral.com]

• Hepatomegaly

  Patients presenting with abdominal pain, hepatomegaly, and ascites should be carefully evaluated from this point of view. [ncbi.nlm.nih.gov]

  Main clinical manifestations included fever, chills, right-upper-quadrant pain, malaise, anorexia, jaundice, and hepatomegaly. [hepatitiscentral.com]

  On examination patient had tachycardia and tender hepatomegaly. Laboratory data showed increased leukocyte count (26,800/μL) with normal liver and kidney function tests. [austinpublishinggroup.com]

• Liver Mass

  Knowledge of the described morphologic patterns influences therapeutic decisions and helps distinguish abscesses from other liver masses. Copyright 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. [ncbi.nlm.nih.gov]

  mass with peripheral daughter cysts hepatic hemangioma hepatic adenoma hepatic infarct : peripheral, segmental distribution, wedge-shaped [radiopaedia.org]

  masses are now recognized as new etiologies of pyogenic abscesses. [16] A study by Tsai et al found recent upper gastrointestinal panendoscopy to be associated with an increased risk of pyogenic hepatic abscess. [17] Cryptogenic No cause is found in [emedicine.medscape.com]

• Pericardial Effusion

  Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail [ncbi.nlm.nih.gov]

• Left Pleural Effusion

  Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail [ncbi.nlm.nih.gov]

• Albumin Decreased

  The size of abscess was correlated with leukocytes increase, albumin decrease, and time duration for body temperature normalization (all p [ncbi.nlm.nih.gov]

  The size of abscess was correlated with leukocytes increase, albumin decrease, and time duration for body temperature normalization (all p p  0.022). [nature.com]

• Citrobacter Koseri

  We report a 56-year-old man with diabetes (operated for periampullary carcinoma 20 years ago), who presented with a history of fever for 1 week and on evaluation was found to have Citrobacter koseri-related hepatic abscess. [ncbi.nlm.nih.gov]

  Clin Infect Dis Off Publ Infect Dis Soc Am 32:326–328. doi: 10.1086/318468 View Article Google Scholar Gupta M, Sharma A, Singh R, Lehl SS (2013) Citrobacter koseri: an unusual cause of pyogenic liver abscess. [springerplus.springeropen.com]

• Streptococcus Bovis

  Streptococcus bovis bacteremia has been linked to the presence of occult colon cancer since 1977. [ncbi.nlm.nih.gov]

• Aggregatibacter Aphrophilus

  Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus/paraphrophilus) is a small Gram-negative coccobacillus with fastidious growth requirements. [ncbi.nlm.nih.gov]

We report an unusual case of a ruptured GFPLA without surgical management, treated successfully with only medical treatment. [ncbi.nlm.nih.gov]

CONCLUSIONS: The prognosis of PLA appears to be dependent on underlying pathologies and severity of condition. More aggressive treatment should be considered if a poor prognosis is expected. [ncbi.nlm.nih.gov]

The prognosis was dismal, with a mean survival of 3.5 months (range, 8 days to 6 months). PMID: 9597257, UI: 98259545 [hepatitiscentral.com]

We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history of diabetes mellitus (DM). The pathogen in the patient with DM was Klebsiella pneumonia (KP). [ncbi.nlm.nih.gov]

BACKGROUND: The epidemiology of pyogenic liver abscess continues to change and the issue of antimicrobial therapy is controversial. This study investigated the epidemiology and clinical outcomes of antimicrobial therapy. [ncbi.nlm.nih.gov]

Singh V, Bhalla A, Sharma N, et al ; Pathophysiology of jaundice in amoebic liver abscess. Am J Trop Med Hyg. 2008 Apr78(4):556-9. [patient.info]

In 1938, Ochsner and Debakey published the largest series of pyogenic and amebic liver abscesses in the literature. [2] Since the late 20th century, percutaneous drainage has become a useful therapeutic option. [3, 4, 5, 6, 7] Pathophysiology Pyogenic [emedicine.medscape.com]

We opine that a hepato-venous fistula is an indication for surgical intervention, and that early resection of the fistula can prevent severe septic complications. [ncbi.nlm.nih.gov]