Author:
VAN GEYT K.,PETROVIC M.,JANSSENS W.
Abstract
A geriatric patient with a perirectal abscess, pylephlebitis and multiple pyogenic liver abscesses: a case-report.
In this case study, an 86-year-old patient is presented with fever, anorexia and drowsiness, a very high C-reactive protein (CRP) level and elevated liver enzymes. Given the frailty of the patient, a non-invasive diagnostic approach was chosen. Initially, a pancreatic carcinoma with liver metastases was suspected, but the presence of positive blood cultures raised doubts about the initially suggested diagnosis. Ultimately, a perirectal abscess with Streptococcus intermedius bacteremia, pylephlebitis and multiple liver and pancreatic abscesses were diagnosed. After a course of 9 weeks of antibiotics, the patient's condition improved.
The vague complaints in this geriatric patient and the lack of invasive diagnostics pose a challenge for the clinician in recognizing this disease.
Reference9 articles.
1. 1. Naymagon L, Tremblay D, Schiano T, Mascarenhas J. The role of anticoagulation in pylephlebitis: a retrospective examination of characteristics and outcomes. J Thromb Thrombolysis 2020; 49: 325-331.
2. 2. Baril N, Wren S, Radin R, Ralls P, Stain S. The role of anticoagulation in pylephlebitis. Am J Surg 1996; 172: 449-452.
3. 3. Duffy FJ Jr, Millan MT, Schoetz DJ Jr, Larsen CR. Suppurative pylephlebitis and pylethrombosis: the role of anticoagulation. Am Surg 1995; 61: 1041-1044.
4. 4. Serraino C, Elia C, Bracco C, et al. Characteristics and management of pyogenic liver abscess: a European experience. Medicine 2018; 97: e0628.
5. 5. Sotto Mayor J, Robalo MM, Pacheco AP, Esperanca S. Pyogenic liver abscess: uncommon presentation. BMJ Case Rep 2016; 2016: bcr2016214841.