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Abstract: The patient was a 67-year-old female, an old diabetic “patient”, who presented with recurrent chills and high fever due to irregular blood glucose control, and was diagnosed with liver abscess after consultation. After hospitalization, the patient was given an insulin pump to control blood sugar, cefoperazone sodium sulbactam sodium for injection to fight infection, and interventional liver abscess puncture and drainage, as well as liver-protective drugs and intravenous nutritional support treatment.
Basic information】Female, 67 years old
Disease Type】Hepatic abscess
Hospital】Zhengzhou People’s Hospital South Campus
Consultation time】April 2022
Treatment plan】Surgical treatment (interventional liver abscess puncture and drainage) + drug treatment (cefoperazone sodium sulbactam sodium for injection, compound glycopyrrolate injection, compound amino acid injection, ibuprofen capsule)
[Treatment period] 15 days of inpatient treatment, followed by outpatient treatment after 1 month
Treatment effect】The drainage tube was removed, and all indicators were normal in the reexamination, and the patient was clinically cured.
I. Initial consultation
After receiving a call from the fever clinic, I went to the fever clinic to see the patient. At first glance, I found that the patient was in very poor mental condition, and through questioning the medical history, I learned that the patient had repeated chills and hyperthermia for 4 days, starting with fever and discomfort in the right upper abdomen, and gradually developing nausea, vomiting and other accompanying symptoms. He was treated with fluids (specific plan unknown) at the community outpatient clinic, but did not see any significant improvement. Emergency blood tests at the fever clinic showed that: leukocytes 21.60×10^9/L; neutrophil percentage 91%. Ultrasound of liver, gallbladder, pancreas and spleen showed that the left lobe of the liver was a heterogeneous echogenic mass containing a liquid dark area with unclear borders, and liver abscess was considered. The patient had a clear consciousness, poor mental health, loss of appetite, poor sleep, normal urine and stool, and no significant change in weight recently. Past history: he had a history of type 2 diabetes mellitus for more than 10 years, and usually took oral metformin hydrochloride tablets and gliclazide tablets irregularly, with poor glycemic control. Physical examination: no yellow staining of skin mucosa and sclera, flat abdomen, positive percussion pain in the liver area.
II. Treatment history
After admission, relevant examinations were actively improved. Liver function suggested: transaminases and alkaline phosphatase were mildly elevated, hypoproteinemia; CT of the chest and abdomen suggested: a small amount of pleural effusion on the right side, liver abscess formation in the left lobe of the liver, fasting blood glucose of 21.6 mmol/L, and blood culture examination was arranged. After admission, the endocrinology department was invited to give insulin pump to control blood glucose, ibuprofen capsule to reduce fever, broad-spectrum antibiotic cefoperazone sodium sulbactam sodium for injection to anti-infection treatment, in addition to hepatoprotective drugs with compound glycyrrhetinic acid injection and intravenous nutritional support treatment with compound amino acid injection, and the patient was instructed to have a high-quality high-protein diet and monitor blood glucose changes.
Although the patient was resistant to the surgery, he agreed to the surgery for the sake of rapid recovery, and the surgery was scheduled for the second day of admission. The patient still had mild fever after the operation, the symptoms subsided quickly after the infusion, and the fever did not appear again in the later period.
Figure 1: Abdominal CT showed an abscess in the left lobe of the liver
Figure 2: External drainage tube of liver abscess by puncture and drainage
III. Treatment effect
After admission, the patient’s diabetic diet was controlled at 7-8 mmol/L with no abnormal fluctuation in blood glucose. After 10 days of treatment, the indexes of blood routine and liver function were basically normal, and there were no fever, abdominal discomfort and other related concomitant symptoms, so the patient was discontinued from anti-infective drug treatment. After 2 weeks of treatment, the liver abscess cavity had disappeared on review ultrasound, and the blood routine and liver function were within the normal range, so the puncture drainage tube was removed, and the patient was observed for 1 day after the drainage tube was removed without any uncomfortable symptoms, and then discharged from the hospital.
IV. Notes
We are glad that after active treatment, the patient’s liver abscess was cured. For the patient, it is important to avoid the triggering factors for recurrence, and after discharge, he must control blood sugar well, regularly monitor the changes of blood sugar, and regularly go to the endocrinology department to adjust the medication. After discharge, take oral anti-inflammatory drug treatment, regularly review blood routine, liver function, abdominal ultrasound and other indicators at the outpatient clinic, and stop the drugs according to the results of the review, and do not stop the drugs privately. If there are chills, fever and right upper abdominal discomfort and other related symptoms, timely follow-up is required to prevent liver abscess from recurring again. Patients are also advised to adjust the diet structure in daily life, pay attention to the combination of meat and vegetables, and should eat more nutritious and easily digestible food, and avoid spicy and stimulating food. Enhance physical exercise to improve their physical quality and strengthen their body resistance.
V. Personal insight
The patient is a bacterial liver abscess, which is common in clinical practice but also easy to be missed, and if not treated in time, the mortality rate is as high as 10%-30%, and once complications are formed, the treatment is very difficult, and in the pre-treatment period, the patient obviously does not pay enough attention to the disease, which leads to rapid progress of the disease. The treatment of liver abscesses lies in early detection and early treatment. For immature liver abscesses with small diameters, systemic supportive therapy and anti-infective treatment can be chosen to achieve the treatment purpose, and patients in this paper can be controlled at that stage if they can get regular treatment very early, but patients have clear indications for surgery from the disease. For single mature liver abscesses with a diameter of 3-5 cm, ultrasound-guided puncture and drainage of liver abscesses can be chosen, and for liver abscesses with larger pus cavities and more divisions, which have formed complications, surgical treatment is recommended, with intraoperative placement of drains for therapeutic purposes. Therefore, for diabetic patients with recurrent chills and high fever must be alert to exclude whether they have liver abscess, which leads to septicemia with the risk of infectious shock and even life-threatening, so they must pay enough attention to it.