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LABORATORY PARAMATERS Day 1 (date of presentation)

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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):


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