Early rectal cancer accompanied by multiple systemic abscesses: A case report

Abstract

Abstract.A 70-year-old man undergoing treatment for diabetes presented with a cough and pyrexia that has lasted one week. Laboratory tests demonstrated evidence of inflammation. The patient was hospitalized and antibiotic treatment was initiated, but the condition of the patient did not improve. After 2 weeks, computerized tomography scanning demonstrated the presence of multiple small nodules in the lungs and a liver abscess. The patient also developed neck pain and numbness of the upper extremities and was then transferred to Tokai University Hachioji Hospital (Tokyo, Japan). Percutaneous transhepatic drainage (PTD) of the liver abscess was performed and antibiotic treatment was initiated. Detailed examination revealed there was pyogenic spondylitis of the cervical spine, therefore abscess drainage and an anterior cervical spinal fusion were performed. Culture of each lesion resulted in Klebsiella pneumoniae growth. While continuing antibiotic treatment and rehabilitation, the gastrointestinal tract was investigated and evidence of early rectal cancer was observed. The pulmonary nodules disappeared during treatment, indicating that these were multiple lung abscesses. Four weeks following abscess drainage and anterior cervical spinal fusion, lower anterior resection was performed. The present case report describes a patient who developed multiple abscesses associated with early rectal cancer and discusses the case with reference to the literature. IntroductionAt present, the global incidence of colorectal cancer is increasing, which is considered to be a result of westernization of the diet and obesity (1-4). The main symptoms are rectal bleeding with or without progressive anemia and weight loss. The recommended treatment for stage I colorectal cancer is surgical resection combined with lymph node dissection (5).The 5-year survival rate of patients following resection of stage I colorectal cancer is 90-95%, with postoperative distant metastasis/recurrence occuring in 5-10% of patients (5). The incidence of postoperative local recurrence in the pelvic cavity is low (5-7). However, it is not uncommon for colon cancer to cause an abscess in a distant organ (8-16). Regarding the pathogenesis of systemic abscesses associated with colorectal cancer, small abscesses may form around the tumor or bacterial invasion may occur secondary to damage to the intestinal wall, which is followed by hematogenous spread (13). The development of abscesses may be promoted by the impaired immunity of tumor-bearing patients and associated diseases, such as diabetes, may also affect immunity (12,13). In the literature, five cases of colorectal cancer in which liver abscesses were the chief complaint have been reported. Of these five cases, 1 early cancer patient (8) and 3 advanced cancer patients exhibited liver abscesses alone (9,10,13) and 1 advanced cancer patient exhibited multiple systemic abscesses (12). Fever was the main symptom in all cases, with weight loss, malaise and nausea/vomiting also observed (8)(9)(10)12,13). In addit...

Case Report: Diagnosis of Primary Klebsiella pneumoniae in Cervical Spine by Metagenomic Next-Generation Sequencing

“…The most common pathogen of spinal infection is Staphylococcus aureus , followed by Streptococcus and Enterococcus ( 3 ). Klebsiella pneumoniae is a common pathogen of nosocomial infections, yet there are few reports of spinal infections caused by K. pneumoniae ( 4 , 5 ). Cervical infection by K. pneumoniae especially preoperative is extremely rare.…”