Yu Megan, Mangaonkar Abhishek, Lovelace Candace, Ibe Michael
Department of Internal Medicine, Medical College of Georgia, Augusta, USA.
Department of Internal Medicine, Georgia Regents University-Medical College of Georgia, Augusta, Georgia, USA.
BMJ Case Rep. 2014 Jun 9;2014:bcr2013202266. doi: 10.1136/bcr-2013-202266.
A 69-year-old Caucasian man presented with fever, chills/rigors and night sweats since 6 days. Blood cultures (4/4) initially reported Gram negative lactose-fermenting rods. Physical examination was fairly benign which included a normal abdominal examination. Laboratory tests were significant for an elevated white cell count, erythrocyte sedimentation rate and C reactive protein . Empirically, he was treated with piperacillin tazobactam. A chart review showed that he had undergone a choledochojejunostomy for a pancreatic head tumour 7 years before. We found a few reported cases of hepatic abscesses after choledochojejunostomy presenting years after the procedure. An abdominal CT scan confirmed our suspicion. Percutaneous drainage was performed and his antibiotics were switched to ciprofloxacin and metronidazole, based on the sensitivity report. The patient's clinical condition steadily improved.
一名69岁的白人男性，自6天前开始出现发热、寒战/畏寒及盗汗。血培养（4次均阳性）最初报告为革兰氏阴性乳糖发酵杆菌。体格检查基本正常，包括腹部检查未见异常。实验室检查显示白细胞计数、红细胞沉降率和C反应蛋白升高。经验性地，给予他哌拉西林他唑巴坦治疗。病历回顾显示，他7年前因胰头肿瘤接受了胆总管空肠吻合术。我们发现有几例胆总管空肠吻合术后数年出现肝脓肿的报告病例。腹部CT扫描证实了我们的怀疑。进行了经皮引流，并根据药敏报告将他的抗生素换成了环丙沙星和甲硝唑。患者的临床状况稳步改善。
