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Abstract: The patient presented with fever 2 weeks before admission and a lung CT showed a little inflammation in the right lower lung. The patient’s temperature returned to normal after 3 days of treatment with intravenous rehydration. One day before admission, fever was reappeared with a temperature as high as 39.5°C. On examination, he was found to have percussion pain in the liver area, and an emergency abdominal CT indicated a hepatic heterogeneous low-density lesion, which was considered a liver abscess, caused by bacterial infection. After administration of antibacterial drugs, the patient’s symptoms were relieved, all indexes recovered, and the liver abscess was reduced in size.
Basic information】Male, 53 years old
Disease Type】Hepatic abscess
Hospital】Huashan Hospital of Fudan University
Date of consultation】January 2022
Treatment plan】Medication (ceftazidime for injection, metronidazole tablets, cefaclor capsules)
Treatment period】4 weeks of inpatient treatment and 2 weeks of self-administered medication
Treatment effect】The patient’s symptoms were relieved, all indexes recovered, and liver abscess was reduced.
I. Initial consultation
The patient had a history of diabetes mellitus in the past, and his fasting blood sugar was usually controlled at 7-8 mmol/L, which was acceptable. Two weeks before admission, the patient developed fever, initially with a temperature of 38℃, which subsided after taking oral Anacin tablets on his own. 2 days later, the patient developed fever again, with a temperature of 39.2℃ and symptoms such as chills and chills, and immediately went to the local hospital for emergency treatment. The routine blood count increased to 12.82×10^9/L, and the CT of the lung showed a little inflammation in the right lower lung. Pneumonia was considered, and the patient was treated with levofloxacin hydrochloride injection and intravenous rehydration for 3 days, and the patient’s temperature returned to normal, and was changed to levofloxacin hydrochloride tablets for oral treatment at home. The patient stopped taking the drug orally after 5 days. One day before admission, the patient had fever again, with body temperature up to 39.5℃, still accompanied by obvious fear of cold and chills. The patient came to our emergency room, and checked the routine blood leukocyte elevation, reaching 13.18×10^9/L, and checked the liver function glutathione transaminase and glutamic oxalacetic transaminase and alkaline phosphatase elevation, and was treated with intravenous rehydration with ceftriaxone sodium injection in the emergency room. I was in the emergency observation room, and during the checkup, I found that the patient had hepatic tap pain, combined with the patient’s history of diabetes and abnormal liver function, and the emergency abdominal CT indicated hepatic heterogeneous low-density lesions, and considered hepatobiliary system infection, and admitted to the ward for further treatment.
II. Treatment history
The patient’s blood culture was drawn immediately after admission, and empirical antibacterial drug ceftazidime for injection plus metronidazole tablet was given according to the diagnosis. On the third day, the patient’s body temperature was basically normal, and the blood culture results showed that the patient had Klebsiella pneumoniae infection causing liver abscess, and the patient continued to be treated with the antibacterial drug ceftazidime for injection plus metronidazole tablets.
(Abdominal enhancement CT results, arrow shows the site of liver abscess)
(Blood culture results showed Klebsiella pneumoniae, which is sensitive to various common antibacterial drugs)
III. Treatment effect
The patient was treated empirically with the antibacterial drug ceftazidime for injection plus metronidazole tablets after admission, and the patient’s body temperature was basically normal on the third day; 1 week later, the routine blood leukocytes had dropped to normal, and the liver function was rechecked, and the glutathione transaminase, glutamic oxalacetic transaminase and alkaline phosphatase all returned to normal. After 4 weeks of antibacterial drug treatment, the intravenous drug was stopped, and the treatment was changed to injectable cefaclor combined with metronidazole tablets orally for another 2 weeks, and the liver abscess was reduced to 1.8cm×1.2cm on re-examination of abdominal CT, and the patient had no fever, and the blood routine and liver function were all back to normal.
IV. Notes
We are glad that the patient’s symptoms have improved after treatment, but liver abscess, as a common bacterial infectious disease, has a long treatment course of 4-6 weeks, so we remind the patient that long-term use of antibacterial drugs needs to pay attention to follow-up blood routine, liver and kidney function at least once a week, pay attention to the side effects of drugs, and if more serious adverse drug reactions occur, the drugs need to be discontinued in time. In addition, if patients have a history of diabetes, they need to control blood sugar to normal range while treating liver abscess, otherwise it is not conducive to infection control.
V. Personal insight
In this case, the patient had fever at the beginning of the disease, but because the patient did not have abdominal pain, nausea, vomiting and other gastrointestinal symptoms, instead, the CT of the lung showed a little inflammation of the right lower lung, so it was misdiagnosed as pneumonia. Although the patient was treated with antibacterial drugs at the beginning of the disease, the dosage was not standardized and the course of treatment was too short, resulting in recurrence of the disease and the patient’s fever again. In clinical practice, we often encounter recurrent fever of unknown origin, and we must pay attention to checking blood routine, liver and kidney function and abdominal CT in order to diagnose liver abscess more quickly and avoid misdiagnosis and omission.