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经动脉化疗栓塞术治疗肝细胞癌后,由纳氏棒状杆菌引起的肝脓肿。

Liver abscess caused by Cutibacterium namnetense after transarterial chemoembolization for hepatocellular carcinoma.

机构信息

Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.

出版信息

Clin J Gastroenterol. 2021 Feb;14(1):246-250. doi: 10.1007/s12328-020-01283-5. Epub 2020 Nov 11.

Abstract

A 72-year-old man underwent transarterial chemoembolization (TACE) for solitary hepatocellular carcinoma (HCC) located on the S6 segment. He had a history of anti-viral therapy for hepatitis C virus and was being treated for diabetes mellitus with inadequate control. On day 28 after TACE, he visited our hospital again, with complaints of fever and abdominal pain in the right upper quadrant. Blood examination showed elevated levels of white blood cells and C-reactive protein. Computed tomography showed a poorly marginated, low-density lesion measuring 9.5 × 8.0 × 4.0 cm, forming multiple small gas bubbles, located superiorly, and in contact with HCC treated by TACE. Ultrasound-guided puncture revealed whiffy and muddy pus. Gram staining of the pus showed the presence of numerous gram-positive rods, which were identified as Cutibacterium namnetense. He underwent percutaneous trans-hepatic abscess drainage and received antibiotics treatment. The abscess was successfully treated, and he was discharged on day 19. The incidence of liver abscess after TACE is rare, and intestinal microbiota have been reported to be the common pathogens. To the best of our knowledge, this is the first case of liver abscess caused by Cutibacterium namnetense.

摘要

一位 72 岁男性因位于 S6 段的单发肝细胞癌(HCC)接受了经动脉化疗栓塞术(TACE)。他有丙型肝炎病毒抗病毒治疗史,并且正在接受糖尿病治疗,但控制不佳。TACE 后第 28 天,他因发热和右上腹疼痛再次来我院就诊。血液检查显示白细胞和 C 反应蛋白水平升高。计算机断层扫描显示边界不清的低密度病变,大小为 9.5×8.0×4.0cm,形成多个小气泡,位于上方,与 TACE 治疗的 HCC 接触。超声引导下穿刺显示有恶臭和浑浊的脓液。脓液革兰染色显示存在大量革兰阳性杆菌,鉴定为 Namnetella 属的 C. namnetense。他接受了经皮经肝脓肿引流术,并接受了抗生素治疗。脓肿得到成功治疗,他于第 19 天出院。TACE 后肝脓肿的发病率较低,肠道微生物群已被报道为常见病原体。据我们所知,这是首例由 Namnetella 属的 C. namnetense 引起的肝脓肿。

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