Chong V H, Yong A M, Wahab A Y
Department of Medicine, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, BA 1710, Brunei Darussalam.
Singapore Med J. 2008 May;49(5):e123-5.
Gas-forming pyogenic liver abscess (GPLA) is rare and is associated with a high mortality rate. It is commonly associated with underlying diabetes mellitus (DM). Gas formation occurs as a result of mixed acid fermentation within the abscess by formic hydrogenlyase, an enzyme produced by certain bacteria. Presentations can be nonspecific leading to a delay in diagnosis. Management includes urgent drainage of the abscess. We report three cases of GPLA as a result of Klebsiella spp. and Escherichia coli infections. All three patients had DM and were very sick at presentation. Diagnosis was delayed in one patient and this likely contributed to his death. Hospitalisations were prolonged. These cases highlight the need to consider GPLA in diabetic patients presenting with fever, abdominal pain, nonspecific symptoms or septic shock.
产气性化脓性肝脓肿（GPLA）较为罕见，且死亡率较高。它通常与潜在的糖尿病（DM）相关。气体形成是由于脓肿内某些细菌产生的甲酸氢解酶进行混合酸发酵所致。临床表现可能不具特异性，导致诊断延迟。治疗包括紧急引流脓肿。我们报告了3例由肺炎克雷伯菌属和大肠杆菌感染引起的GPLA病例。所有3例患者均患有糖尿病，就诊时病情都很严重。1例患者诊断延迟，这可能是导致其死亡的原因。住院时间延长。这些病例凸显了对于出现发热、腹痛、非特异性症状或感染性休克的糖尿病患者，需要考虑GPLA的可能性。
