Takahashi Koji, Ohyama Hiroshi, Ohno Izumi, Takiguchi Yuichi, Kato Naoya
Gastroenterology, Chiba University, Chiba, JPN.
Medical Oncology, Chiba University, Chiba, JPN.
Cureus. 2023 Dec 29;15(12):e51277. doi: 10.7759/cureus.51277. eCollection 2023 Dec.
Liver abscesses caused by with a positive string test for hyperviscosity are more likely to develop invasive conditions than those with a negative string test. Here, we report the case of primary sclerosing cholangitis (PSC) who developed a treatment-resistant liver abscess caused by hyperviscous . A 67-year-old woman with PSC and a history of pancreaticoduodenectomy developed a fever. She had recurrent bacterial cholangitis after pancreaticoduodenectomy. This time, she was diagnosed with a liver abscess and bacterial cholangitis and then admitted to a local hospital. As her condition did not improve with intravenous administration of meropenem, she was transferred from another hospital to our hospital on the 7th day of admission. The percutaneous transhepatic abscess drainage was performed, and intravenous administration of cefepime and metronidazole was started. with a positive string test was detected in the blood culture test and the pus culture of the liver abscess. Although the liver abscess was reduced in size, the infection did not subside completely. Her general condition gradually deteriorated. She passed away on the 45th day of illness. In PSC patients, the formation of a liver abscess caused by hyperviscous can be life-threatening. In such cases, pus should be collected as soon as possible to identify the causative bacteria.
对于拉丝试验呈高粘度阳性的肝脓肿，与拉丝试验阴性的肝脓肿相比，更易发展为侵袭性病症。在此，我们报告一例原发性硬化性胆管炎（PSC）患者，其因高粘性[具体物质未明确]引发了难治性肝脓肿。一名67岁患有PSC且有胰十二指肠切除术病史的女性出现发热症状。她在胰十二指肠切除术后反复发生细菌性胆管炎。此次，她被诊断为肝脓肿和细菌性胆管炎，随后入住当地医院。由于静脉输注美罗培南后病情未改善，她在入院第7天从另一家医院转至我院。进行了经皮肝脓肿穿刺引流，并开始静脉输注头孢吡肟和甲硝唑。血培养及肝脓肿脓液培养检测到拉丝试验呈阳性的[具体物质未明确]。尽管肝脓肿体积缩小，但感染并未完全消退。她的总体状况逐渐恶化。发病第45天去世。在PSC患者中，由高粘性[具体物质未明确]引起的肝脓肿形成可能危及生命。在此类情况下，应尽快采集脓液以鉴定病原菌。
