Pyogenic liver abscess associated with large colonic tubulovillous adenoma

Abstract

tract disease or intra-abdominal infections including cholecystitis, suppurative cholangitis, suppurative pylephlebitis, appendicitis, diverticulitis and peritonitis [1][2][3] . Recently, colorectal cancer without obvious infection was considered as one of the uncommon etiologies of liver abscess [4,5] . Furthermore, liver abscess was reported as the presenting manifestation of colonic tubulovillous adenoma [6] . However, there are a growing number of reports suggesting a relationship between diabetes mellitus (DM) and Klebsiella pneumonia (KP) liver abscess which indicate that a deficiency in the hosts' defense mechanism could be the etiology of this liver infection [7][8][9] . We hereby report two cases of pyogenic liver abscess both of which were found to have colonic tubulovillous adenoma two to three weeks later after the diagnosis of liver abscess. The association of pyogenic liver abscess and colonic tubulovillous adenoma and the implications of these two cases are discussed. CASE REPORT CASE 1A 67-year-old man, who was referred from a local hospital, was admitted to our hospital because of fever, chill, and right upper abdominal pain for seven days. On physical examination, his initial body temperature was 37.9 o C and blood pressure was 124/67 mmHg. Light palpation of the abdomen revealed tenderness and mild rebounding pain on epigastric and right upper areas, but no abdominal mass was felt. Significant laboratory data included a leukocyte count of 26,330/mL (normal range = 4000-10,400/mL ), a hemoglobin of 9.5 gm/dL (normal range = 12-16 gm/dL), an aspartate aminotransferase (AST) of 73 IU/L (normal range = 5-34 IU/L), an alanine aminotranferase (ALT) of 79 IU/L (normal range = 0-40 IU/L), a fasting blood sugar of 118 mg/dl (normal range = 70-110 mg/dL), a total bilirubin of 1.03 mg/dL (normal range = 0.2-1.3 mg/dL), a C-Reactive Protein (CRP) of 17.02 mg/dL (normal <0.8 mg/dL), and a carcinoembryonic antigen (CEA) level of 0.33 ng/dL (normal <5 ng/dL).Abdominal ultrasonography (US) and computed tomography (CT) showed a 4-cm liver abscess in left lobe of liver ( Figure 1A). After three sets of blood cultures were completed and broad-spectrum antimicrobial therapy was initiated, CT-guided percutaneous drainage of the liver abscess was performed and pus liked material was aspirated and sent for bacterial culture. However, blood and pus were all negative for bacterial growth. As antimicrobial treatment was continued, the patient's clinical condition improved rapidly and fever subsided four days CASE REPORT P yo g en ic liver absc ess a s s o c i a t e d w i t h l a r g e c o l o n i c tubulovillous adenomaHsueh-Chou Lai, Cho-Yu Chan, Cheng-Yuan Peng, Chih-Bin Chen, Wen-Hsin Huang AbstractPyogenic liver abscesses usually occur in association with a variety of diseases. Rarely, liver abscess has been reported as the presenting manifestation of colonic tubulovillous adenoma. We report two cases of pyogenic liver abscess without hepatobiliary disease or other obvious etiologies except that one had a history ...

A solid organising cryptogenic liver abscess and its association with a colonic tubullovillous adenoma

“…However, its association with tubullovillous adenomas has rarely been reported, with only one case published in the English literature 6. Here we present a case of a CLA possibly initiated by a tubullovillous adenoma in the colon.…”

“…Cryptogenic liver abscess (CLA) has been well recognised as the possible initial manifestation of a silent colorectal carcinoma 6 7. However, its association with tubullovillous adenomas has rarely been reported, with only one case published in the English literature 6.…”

Computed Tomographic Colonography Is Valuable for Post-Treatment Evaluation and Screening of Hidden Colorectal Cancer in Patients with Cryptogenic Pyogenic Liver Abscess

“…In particular, the prevalence of advanced adenoma in this study (9.9%, 9/91 polyps) was also higher than that in general population (7.5%, 226/2,995 polyps) [29] despite limited statistical power due to small number of patients. It appears that PLA could develop at the stage of colonic adenoma [7,8]. Hence, an effort to detect adenomatous polyps in PLA patients is amply reasonable.…”

“…PLA is associated with hepatobiliary tract disease or intra-abdominal infections [2]. In addition, PLA has been reportedly related to various colonic diseases, such as inflammatory bowel disease [3,4], diverticulitis [5,6], colonic adenoma [7,8], and colorectal cancer (CRC) [9,10,11,12,13,14,15]. The term ‘cryptogenic PLA' is used when a significant underlying cause of PLA cannot be determined.…”

Cryptogenic pyogenic liver abscess as a sign of colorectal cancer: a population-based 5-year follow-up study

“…Recent reports assert that cryptogenic PLA might be a presentation of occult or silent colorectal cancer or adenoma without any gastrointestinal symptoms on admission (5, 7, 8, 14). Studies by Cohen et al (6), Nosher et al (28) and Yeh et al (29) revealed that 5% (1/20 patients), 6.7% (1/15 patients) and 11.5% (6/52 patients) of patients with PLA had colorectal cancer respectively.…”