Rasic Petar, Bosnic Srdjan, Vasiljevic Zorica V, Djuricic Slavisa M, Topic Vesna, Milickovic Maja, Savic Djordje
Department of Abdominal Surgery, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Radoja Dakica 6-8, Belgrade, Serbia.
Department of Clinical Microbiology, Mother and Child Health Care Institute of Serbia "Dr. Vukan Cupic", Radoja Dakica 6-8, Belgrade, Serbia.
BMC Gastroenterol. 2020 Aug 14;20(1):267. doi: 10.1186/s12876-020-01409-6.
A pyogenic liver abscess (PLA) represents a pus-filled cavity within the liver parenchyma caused by the invasion and multiplication of bacteria. The most common offender isolated from the PLA in children is Staphylococcus aureus. Abiotrophia defectiva is a Gram-positive pleomorphic bacterium, commonly found in the oral cavity, intestinal, and genitourinary mucosa as part of the normal microbiota. It has been proven to be an etiological factor in various infections, but rarely in cases of PLA. The case presented here is, to the best of our knowledge, the first pediatric case of PLA caused by A. defectiva.
A 13-year-old Caucasian boy presented with a two-day history of abdominal pain, fever up to 40 °C, and polyuria. Contrast-enhanced computed tomography (CT) scan revealed a single, multiloculated liver lesion, suggestive of a liver abscess. The boy had sustained a bicycle handlebar injury to his upper abdomen 3 weeks before the symptoms appeared and had been completely asymptomatic until 2 days before admission. He was successfully treated with antibiotic therapy and open surgical drainage. A. defectiva was isolated from the abscess material. Histopathology report described the lesion as a chronic PLA.
A. defectiva is a highly uncommon cause of liver abscess in children. In such cases, various predisposing factors should be considered, including antecedent blunt abdominal trauma.
化脓性肝脓肿（PLA）是肝实质内由细菌侵入和繁殖引起的充满脓液的腔隙。儿童化脓性肝脓肿中最常见的分离病原菌是金黄色葡萄球菌。缺陷乏养菌是一种革兰氏阳性多形性细菌，作为正常微生物群的一部分，常见于口腔、肠道和泌尿生殖黏膜。它已被证明是各种感染的病因，但在化脓性肝脓肿病例中很少见。据我们所知，本文所呈现的病例是首例由缺陷乏养菌引起的儿童化脓性肝脓肿。
一名13岁的白种男孩出现腹痛、高达40°C的发热和多尿症状，持续两天。增强计算机断层扫描（CT）显示肝脏有一个单房、多分隔的病变，提示肝脓肿。该男孩在症状出现前3周上腹部曾被自行车车把撞伤，在入院前两天之前一直完全无症状。他通过抗生素治疗和开放手术引流成功治愈。从脓肿材料中分离出缺陷乏养菌。组织病理学报告将病变描述为慢性化脓性肝脓肿。
缺陷乏养菌是儿童肝脓肿极少见的病因。在这类病例中，应考虑各种易感因素，包括既往腹部钝性创伤。
