Multiple Liver Abscesses Secondary to Yersinia Enterocolitica.

Abstract

A 37-year-old male, a poorly-controlled insulin-dependent diabetic patient, was admitted to our hospital with complaints of high fever and confusion. Laboratory data showed hyper glycemia, positive inflammatory reaction and liver dysfunction. Blood culture demonstrated Yersinia enterocolitica. Liver CT scan showed multiple low density areas. These data were consistent with a diagnosis of liver abscess secondary to Yersinia enterocolitica. He died of disseminated intravascular coagulation; subsequent autopsy confirmed the clinical diagnosis. Liver abscess secondary to Yersinia enterocolitica with septicemia is rare, but has been reported in compromised hosts. In the mechanism of this disease, the alimentary tract has been suggested to be the port of entry in most cases. (Internal Medicine 31: 1125-1127, 1992 Key words: sepsis, diabetes mellitus, serotype 03 antibody, hepatic encephalopathy Intr oductionWe treated a case of sepsis and multiple liver ab scesses due to Yersinia enterocolitica (Y.E) in an insulin dependent diabetes mellitus patient. In Japan, it is rare to find severe infection caused by Y.E., especially in adult patients. Case ReportA 37-year-old diabetic man was treated with insulin for ten years, but his diabetic condition was not well controlled. On September 27, 1986, he began to suffer from high fever and diarrhea; nausea, vomiting and mild disturbance of consciousness later developed, and he was admitted to our hospital on November 7, 1986. On admission, BP was 94/70 mmHg, body temperature was 37.4°C, and consciousness was confused. The patient's skin was dry; there were no other abnormal findings on physical examination.Laboratory data showed WBC 5800/mm3 (Band 3, Seg (Fig. 1) showed multiple round low density areas (2-5cm in diameter) in the bilateral lobes of the liver. Ultrasound also showed multiple clear margins around hypoechoic lesions. These data suggested liver abscesses secondary to Y.E. with septicemia. Chemo therapy was started with ceftizoxime (CZX) 6g/day; piperacillin (PIPC) 4 g/day was later added. Neurological signs (flapping tremor, confusion and dyscalculia) were thought to be caused by hepatic encephalopathy. Lactulose and aminoleban were administrated, and the patient's serum ammonia level decreased, but the disturbance of consciousness did not show any improvement. Spike fever continued and serum albumin decreased to 0.9 g/dl.Generalized edema, pulmonary effusion, ascites and jaundice developed. Diuretics and frozen fresh plasma were administered, but hypoalbuminemia, generalized edema, and pulmonary effusion failed to improve. On the 17th day after admission, gastrointestinal bleeding occured. He died of disseminated intravascular coagu lation (DIC) and pulmonary edema on the 29th day after admission.

Miliary abscess of the liver: unusual complication of intestinal perforation

“…The typical presentation which may suggest the diagnosis of miliary liver abscess includes abdominal pain and hepatomegaly [ 4 ]. Two variations in presentation have been identified, which depend on the type of bacteria causing the infection.…”

“…On the other hand, cases of miliary liver abscess caused by Mycobacterium tuberculosis follow a more indolent course with low-grade fever and little or no systemic inflammatory response syndrome [ 6 ]. The diagnosis is confirmed by contrast-enhanced CT scan showing 1–3 mm, homogeneous hypodensities disseminated in the hepatic parenchyma [ 4 ]. This must be distinguished from metastatic miliary malignancy, as described by Pichon et al.…”

“…The bacteria isolated on blood culture was E. coli , which suggests a gastrointestinal source. Septicemia is the most common mechanism of miliary abscess formation [ 5 ], and the intestine represents the main gateway for contamination through portal diffusion [ 4 ]. A similar case was described in a patient who presented a diverticular perforation of the sigmoid colon complicated by miliary abscess of the liver [ 7 ].…”

Yersiniosis I: Microbiological and Clinicoepidemiological Aspects of Plague and Non-Plague Yersinia Infections

“…Systemic or septicemic infection with Yersinia enterocolitica and Yersinia pseudotuberculosis is characterized by frequent bacteraemia and a metastatic potential for the development of focal suppurative, hematogenouslyseeded lesions located in various tissues and organs. Previously described metastatic lesions include hepatic, splenic and renal abscesses [128][129][130][131][132][133][134][135][136][137][138][139][140][141], osteomyelitis and septic arthritis [139][140][141][142][143][144][145][146], meningitis [147], peritonitis [148][149][150][151][152], pulmonary infiltrates, lung abscess and empyema [145,146,[153][154][155][156], mycotic aneurysms [157,158], endocarditis [159,160], endophthalmitis [147], and skin and soft tissue infections [161]. Exudative pharyngitis caused by Yersinia enterocolitica has also been described in recent years [162,163].…”