Malkoc Aldin, Mamoun Lana, Cremat Danielle, Barmanwalla Amira, Phan Alexander, Daoud Amanda, Perez Kevin, Woodward Brandon
Arrowhead Regional Medical Center.
California University of Science and Medicine, Colton, CA, USA.
Ann Med Surg (Lond). 2024 Jun 14;86(8):4870-4874. doi: 10.1097/MS9.0000000000002278. eCollection 2024 Aug.
is a bacteria that can be found in normal oral and gastrointestinal flora. infection is rare in immunocompetent patients but is known to cause periorbital cellulitis, endocarditis, osteomyelitis and bacteremia; however, its association with acute respiratory distress syndrome (ARDS) has not been previously documented.
A 36-year-old female with no known history who presented with right-sided chest, flank and upper abdominal pain after a motor vehicle accident. Computed tomography showed multiple right rib fractures, small right pneumothorax, and a grade 4 liver laceration with active extravasation of the posterior aspect of the right liver lobe. Over the hospital course, the patient developed ARDS and was intubated for hypoxemia. A right posterior liver abscess was percutaneously drained, with a copious amount of air and ~30 ml turbid fluid aspirated. Cultures from the liver abscess grew . She was treated with Micafungin, Levofloxacin, and Metronidazole for the hepatic abscess, and was discharged home with outpatient follow-up.
The authors present one of the first reported cases of a infected liver abscess associated with ARDS in an immunocompetent patient.
These clinical findings are unique due to the nature of our patient's ARDS onset and the dearth of similar cases in the literature. The favorable outcome of our patient was due to a multidisciplinary and early identification of a hepatic abscess. The authors' findings contribute to the future management of and a greater understanding of its disseminating effects and presentation in immunocompetent patients.
是一种可在正常口腔和胃肠道菌群中发现的细菌。在免疫功能正常的患者中感染罕见，但已知可引起眶周蜂窝织炎、心内膜炎、骨髓炎和菌血症；然而，其与急性呼吸窘迫综合征（ARDS）的关联此前尚未见文献报道。
一名36岁女性，无已知病史，在机动车事故后出现右侧胸部、胁腹和上腹部疼痛。计算机断层扫描显示右侧多发肋骨骨折、小量右侧气胸以及4级肝裂伤，右肝叶后部有活动性出血。在住院过程中，患者发展为ARDS并因低氧血症插管。经皮引流右后肝脓肿，抽出大量气体和约30毫升浑浊液体。肝脓肿培养物培养出 。她接受了米卡芬净、左氧氟沙星和甲硝唑治疗肝脓肿，并出院接受门诊随访。
作者报告了免疫功能正常患者中首例与ARDS相关的 感染性肝脓肿病例之一。
由于我们患者ARDS发作的性质以及文献中类似病例的缺乏，这些临床发现是独特的。我们患者的良好结局归因于多学科以及早期识别出 肝脓肿。作者的发现有助于未来对 的管理，并加深对其在免疫功能正常患者中的播散效应和表现的理解。
