Wang Y Y, Lee F Y, Chang F Y, Lee S D, Fung C P
Department of Medicine, Veterans General Hospital-Taipei and National Yang-Ming University, Taiwan, ROC.
J Microbiol Immunol Infect. 1998 Dec;31(4):249-52.
Septic metastasis is a unique feature of Klebsiella pneumoniae liver abscess in Taiwan. The case we report is a vanishing K. pneumoniae liver abscess with septic metastasis of the chest wall. The initial finding of a 36 year-old male with no previous medical history, was a huge hepatic mass presented on the sonography during a physical checkup. Hepatitis B, C serology, tumor markers and evidence of metastatic diseases were all negative. A computerized tomography examination was also inconclusive about its nature. Due to the patient's refusal of a liver biopsy, only oral antibiotics were medicated at the outpatient department. Unexpectedly, the follow-up computerized tomography, taken 4 weeks later, demonstrated that the liver mass was nearly absent, while a protruding painful lesion developed over the right chest wall. Under sono-guided aspiration, the chest wall mass was proved to be a pyogenic abscess. The Gram stain revealed gram-negative bacilli and the bacterial culture yielded K. pneumoniae. Under the impression of K. pneumoniae liver abscess with chest wall septic metastasis, after performing percutaneous drainage of the chest wall abscess, the patient was only given parenteral antibiotics for treatment. Both the liver and the chest wall abscesses were at last completely eradicated.
脓毒性转移是台湾地区肺炎克雷伯菌肝脓肿的一个独特特征。我们报告的病例是一例胸部壁层发生脓毒性转移的正在消失的肺炎克雷伯菌肝脓肿。一名36岁、既往无病史的男性患者，最初在体检超声检查时发现肝脏有巨大肿块。乙肝、丙肝血清学检查、肿瘤标志物及转移疾病证据均为阴性。计算机断层扫描检查也无法确定其性质。由于患者拒绝肝脏活检，门诊仅给予口服抗生素治疗。出乎意料的是，4周后进行的后续计算机断层扫描显示肝脏肿块几乎消失，而右胸壁出现一个突出的疼痛性病变。在超声引导下穿刺抽吸，证实胸壁肿块为化脓性脓肿。革兰氏染色显示革兰氏阴性杆菌，细菌培养结果为肺炎克雷伯菌。在诊断为肺炎克雷伯菌肝脓肿伴胸壁脓毒性转移后，在对胸壁脓肿进行经皮引流后，仅给予患者静脉抗生素治疗。肝脏和胸壁脓肿最终均完全根除。
