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Title : A 55 year-old female w/ Fever, RUQ pain
Date : November 1, 2010
Contributed by

Kyungmin Huh, M.D.

Department of Internal Medicine

Samsung Medical Center, Sungkyunkwan University School of Medicine

Patient History
Age/Sex A 55 year-old female
Chief complaint Fever, RUQ pain
Present illness

A 55 year-old female without significant prior medical history presented with fever, headache and abdominal pain in right upper quadrant. Complete blood count showed marked eosinophilia (26.6%), and abdomen CT revealed multiple low-attenuated lesions. Liver abscess was suspected and second generation cephalosporin and metronidazole were started. Later, liver biopsy was reported to be consistent with eosinophilic liver abscess. Methylprednisolone 60mg IV was administered for 32 days and then tapered to oral prednisolone. She became febrile again after discontinuation of prednisolone and was transferred to Samsung Medical Center. Ceftriaxone and metronidazole were restarted and liver biopsy was performed.  During the hospital courses, abdominal pain and eosinophilia were aggravated despite the use of antibiotics. Abdomen CT and liver biopsy were followed-up and they showed progression of abscess.

Physical examination

The patient had fever of 38.2'C. She had tenderness on right upper quadrant of the abdomen without rebound tenderness. Physical exam was otherwise unremarkable.

Initial laboratory findings

The CBC was 5540 (segmented neutrophil 65%, eosinophil 3%) - 12.3 - 202K. CRP was elevated to 14.17. LFT was within normal limits with total bilirubin 1.1, AST 25, ALT 45

Radiologic findings



 
Question - ID Case of the Week ( November 1, 2010 )
What is the most probable microorganism of liver abscess in this patient?
Please send us your answer to the following e-mail address ( nuove@ansorp.org ).
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