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]

• 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 [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]

  A 44-year-old man with diabetes mellitus presented to our hospital after 4 days of fever and abdominal pain. [nejm.org]

• 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 [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]

  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]

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

  […] biliary cystadenoma hepatic peliosis hydatid cyst : large cystic liver mass with peripheral daughter cysts hepatic hemangioma hepatic adenoma hepatic infarct : peripheral, segmental distribution, wedge-shaped [radiopaedia.org]

  […] trauma and liver necrosis from inadvertent vascular injury during laparoscopic cholecystectomy are recognized causes of liver abscess. [8] In addition, transarterial embolization and cryoablation of liver masses are now recognized as new etiologies of [emedicine.medscape.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]

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

If left untreated, the PLA runs a lethal course, so an adequate treatment should be performed. This treatment can be medical (antibiotic) which can be associated with interventional (percutaneous aspiration or drainage) or surgical treatment. [ghrnet.org]

Chou FF, Sheen-Chen SM, Chen YS, Chen MC: Single and multiple pyogenic liver abscess: Clinical course, etiology and results of treatment. World J Surg 1997;21:384–389. [karger.com]

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]

Etiology Etiology by source References: [5] [6] [1] [2] [7] [8] [9] [10] [11] [12] Risk factors Clinical features Classic triad of pyogenic liver abscess Fever (with/without chills and rigors) Malaise Right upper quadrant pain (up to 75% of patients) [amboss.com]

Branum GD, Tyson GS, Branum MA, Meyers WC: Hepatic abscess changes in etiology, diagnosis and management. Am Surg 1990;212:655–662. [karger.com]

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]

Epidemiology References: [1] [2] [3] [4] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

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]

The early recognition of the disease, prompt use of empirical antimicrobial therapy, initiation of drainage in the appropriate patients, and controlling the underlying conditions were crucial for preventing severe sepsis and improving the outcome. [ncbi.nlm.nih.gov]

Prompt treatment of abdominal and other infections may reduce the risk of developing a liver abscess, but most cases are not preventable. [ufhealth.org]