1. LABORATORY PARAMATERS Day 1 (date of presentation)
Pyogenic liver abscess masquerading as liver metastasis in a patient with ulcerative colitis
Varun Kesar M.B.B.S1 , Kelly Teagle D.O2, Vivek Kesar M.D3, Arun Swaminath M.D2
Department of Internal Medicine – Lenox hill hospital, New York, New York.2Department of Gastroenterology – Lenox hill hospital, New York, New York
3Department of Gastroenterology- Stony Brook University Hospital, Stony Brook, New York. .
Would need biopsy slides – I have ed Dr. Fiel couple of times, I would need your help Dr. Odin
Should we add picture of Echinacea bottle – I just google and copied from internet
Background
IMAGES
HISTOPATHOLOGY
Pyogenic liver abscess (PLA) is a rare and severe extra-intestinal complication in patients with inflammatory bowel disease (IBD).
Patients with ulcerative colitis were more likely to develop PLA than were those with Crohn's disease.
Image 3 : Liver biopsy, showing massive neutrophil infiltration with extensive hepatocyte loss consistent with abscess .
CASE REPORT
A 74-year-old female with UC presents with bloody diarrhea and worsening abdominal discomfort for past one month .
She denied any recent travel, sick contacts or antibiotic usage. She met severe sepsis criteria on admission and was admitted in ICU.
CT Scan revealed pan-colitis and multiple masses in liver concerning for malignancy. Tumor markers were : CA , CA CAE and AFP were WNL.
CT guided biopsy of 5cm liver lesion revealed an abscess (Image 3). Patient was started on IV Piperacillin-Tazobactam, which was de-escalated to ceftriaxone.
Stool studies (Clostridium difficle, O & P screen , Stool culture ) were negative.
She was discharged home with 6 weeks of IV ceftriaxone with improvement in clinical symptoms and leukocytosis.
Image : 1
Image : 2
Image 1: CT scan showing multiple liver masses .
Image 2: Ultrasound showing multiple metastasis .
Discussion
LABORATORY PARAMATERS
Symptoms of PLA are nonspecific and may masquerade as liver metastasis.
Necrosis and bleeding within a tumor may lead to a fluid-filled appearance making radiographic differentiation from abscess challenging, requiring histopathological diagnosis.
This case highlights , the importance of PLA, a complication of UC.
Lab Parameters (normal range)
Day 1 (date of presentation)
AST(1-50 U/L)
125
ALT(1-53 U/L) 65
ALP ( U/L)
161
Total Bilirubin (0.1 – 1.2 mg/dL)
12.7
WBC
17.6
ESR
149
Calprotectin
610
BIBLIOGRAPHY
Pyogenic liver abscess in patients with inflammatory bowel disease: a nationwide cohort study. Liver Int Jan;36(1):