Li Fang, Zheng Wenfei, Yu Jian, Zhao Linyan
Department of Stroke Center, Dalian Municipal Central Hospital, Dalian, China.
Department of Critical Care Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China.
Front Surg. 2022 Aug 24;9:894929. doi: 10.3389/fsurg.2022.894929. eCollection 2022.
This is a rare but typical case of a liver abscess with migratory infections including purulent meningitis and endogenous endophthalmitis. The patient had a chief complaint of 7 days of fever, 4 days of blurry vision, and 4 h of glossolalia. Ultrasound scan and computed tomography (CT) suggested a liver abscess. Both blood and drainage fluid cultures grew with a high mucosal phenotype. The patient was finally diagnosed with a liver abscess, purulent meningitis, and endogenous endophthalmitis in the right eye. Ultrasound-guided percutaneous catheter drainage (PCD) of the liver abscess was performed, and meropenem was used to control infection. The patient was given 0.1 ml of vancomycin (10 g/L) and 0.1 ml of ceftazidime (20 g/L) were by intravitreal injection for the treatment of endophthalmitis. The infection was gradually controlled after such treatments. The patient was discharged from our hospital with an improved condition. However, during the time of follow-up, she developed complications due to severe pneumonia and eventually died in a local hospital. This case revealed that a rapid diagnosis followed by appropriate treatment would improve prognosis and prevent severe metastatic complications.
这是一例罕见但典型的肝脓肿合并迁徙性感染病例,包括化脓性脑膜炎和内源性眼内炎。患者的主要诉求为发热7天、视力模糊4天以及胡言乱语4小时。超声扫描和计算机断层扫描(CT)提示肝脓肿。血液和引流液培养均培养出高黏液型菌株。该患者最终被诊断为肝脓肿、化脓性脑膜炎以及右眼内源性眼内炎。对肝脓肿进行了超声引导下经皮导管引流(PCD),并使用美罗培南控制感染。通过玻璃体内注射给予患者0.1毫升万古霉素(10克/升)和0.1毫升头孢他啶(20克/升)以治疗眼内炎。经过这些治疗,感染逐渐得到控制。患者病情好转后从我院出院。然而,在随访期间,她因严重肺炎出现并发症,最终在当地一家医院死亡。该病例表明,快速诊断并给予恰当治疗可改善预后并预防严重的转移性并发症。