A rare case of pericarditis and pleural empyema secondary to transdiaphragmatic extension of pyogenic liver abscess

作者：Cho Eunae; Park Sang Woo; Jun Chung Hwan^*; Shin Sang Soo; Park Eun Kyu; Lee Kyo Seon; Park Seon Young; Park Chang Hwan; Kim Hyun Soo; Choi Sung Kyu; Rew Jong Sun

来源：BMC Infectious Diseases, 2018, 18(1): 40.

DOI：10.1186/s12879-018-2953-8

• Liver abscess
• Pericarditis
• Empyema
• Klebsiella pneumoniae

Background: Transdiaphragmatic extension of pyogenic liver abscess is the rarest cause of pericarditis and pleural empyema. It is a rapidly progressive and highly lethal infection with mortality rates reaching 100% if left untreated. However, the transmission route, treatment methods and prognosis have not been well studied.
Case presentation: A 65-year-old male patient presented with a fever, dyspnea, and right upper quadrant abdominal pain. Computed tomography of the chest and abdomen showed huge liver abscess without full liquefaction in the left lobe, large amount of left pleural effusion, and mild pericardial effusion, and the patient was treated with parenteral antibiotics and pigtail insertion at the left pleura. However, four days later, cardiac tamponade was developed and surgical drainage of the abscess and pericardium was performed. Klebsiella pneumonia was isolated from pleural empyema. Twenty-five days after surgery, the patient was discharged without any complications.
Conclusions: Herein, we report a rare case of pleural empyema and pericarditis in that resulted from the extension of huge pyogenic liver abscess. Early surgical treatment may have prevented progression of the pericarditis to the more dismal purulent pericarditis. We also review pertinent English literature on pericarditis as a complication of PLA.

• 出版日期2018-1-15