Psoas abscess and bacterial peritonitis caused by urinary tract infection in a patient of liver cirrhosis and diabetes mellitus

Abstract

Prognosis of patients with diabetes mellitus or liver cirrhosis can be worsened by the development of a variety of infectious diseases. We describe a case of psoas abscess and bacterial peritonitis in a 58-year-old woman with type C liver cirrhosis and diabetes mellitus hospitalized after having an elevated temperature caused by urinary tract infection for 2 months. The cirrhosis had not been treated and daily self-administration of insulin had been discontinued for the previous 5 months. On day 2 of hospitalization, vomiting and decreased blood pressure developed. Abdominal computed tomography scan revealed ascites, pneumoperitoneum, and psoas abscess. Laparotomy revealed psoas abscess and bacterial peritonitis without gastrointestinal perforation and psoas abscess perforation. Surgical drainage of the abscess and peritoneal cavity was performed. Immediately after the operation, upper gastrointestinal bleeding, shock, hypoglycemia, and metabolic acidosis developed, followed by hepatic failure, renal insufficiency, and cerebral dysfunction. Death occurred on postoperative day 19. Upon autopsy, bacterial peritonitis residue of psoas abscess, and urinary tract infection were confirmed. We surmise that untreated liver cirrhosis and diabetes mellitus is a risk for urinary tract infection that may spread in iliopsoas and free peritoneal space.

Clinical Characteristics of Diabetes Complicated by Bacterial Liver Abscess and Nondiabetes-Associated Liver Abscess

“…With the increasing morbidity of diabetes in recent years, the incidence of diabetes combined with BLA has also continued to increase, mainly because a chronic increase in blood glucose can cause an increased plasma osmotic pressure, leading to inhibition of leukocyte chemotaxis, phagocytosis, and adhesion resulting in lowered immunity. This is beneficial for bacterial multiplication and growth, resulting in hepatapostema, and a great threat to the quality of life, as well as the mental and physical health of patients [ 1 – 3 ].…”