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AIMS: Hepatic inflammatory pseudotumours (IPTs) are nonneoplastic hepatic masses characterized by variably fibroblastic stroma and inflammatory infiltrate, hypothesized to arise as part of a response to infection or prior surgery. The aim of this study was to evaluate the clinicopathologic features and outcomes of biopsy-proven hepatic IPT as well as other cases with IPT-like histologic features. METHODS AND RESULTS: A database search at our institution identified cases with a pathologic diagnosis of hepatic IPT (n = 80) between 2000 and 2023. Histologic features (stromal quality, inflammatory cell components, granulomas, and necrosis) were evaluated. Past medical and surgical history, microbiologic studies, and outcomes were reviewed retrospectively. Patients frequently had a past medical history of malignancy (34%), biliary disease (15%), or prior intraabdominal surgery (24%), and often presented with multifocal hepatic lesions (36%). Variable inflammatory backgrounds were present, including histiocytic (36%), lymphoplasmacytic (34%), or neutrophilic (24%). Specific organisms were identified in 15% of cases, most commonly Klebsiella and Staphylococcus species. Most patients with available clinical follow-up demonstrated radiologic resolution and/or had repeat negative biopsy; a minority of patients (8%) were subsequently diagnosed with neoplastic hepatic lesions. No significant association was seen between histologic features and the subsequent clinical or pathologic diagnosis of hepatic neoplastic lesions. CONCLUSIONS: Hepatic IPT is a heterogeneous entity that can present in a variety of clinical scenarios and show a wide morphologic spectrum. These lesions often regress spontaneously or with antibiotics. A subset of cases with hepatic IPT-like histologic features were subsequently diagnosed with malignancy, emphasizing the need for continued follow-up and repeat biopsy depending on clinical and radiologic features.

Intrahepatic abscess is an exceedingly rare complication of locoregional therapy for patients with liver cancer. However, in patients who underwent prior hepatobiliary intervention, the incidence of liver abscess increases significantly, causing morbidity and even mortality in such patients. Here, we will review the relative risk of developing a liver abscess after intraarterial and ablative locoregional therapies in patients with liver cancer depending on whether they underwent any kind of prior hepatobiliary procedures that resulted in violation of the Ampulla of Vater. As a result, patients deemed at high risk of developing a liver abscess were treated prophylactically, with the combination of bowel preparation and antibiotics nearly eliminating the occurrence of a liver abscess after locoregional therapy. Therefore, given the significant risk of developing a liver abscess in patients with prior hepatobiliary procedures, management consisting of prophylactic bowel preparation with antibiotic coverage followed by antibiotics post-locoregional therapy is recommended. [ABSTRACT FROM AUTHOR]

Laparoscopic cholecystectomy is the preferred method for treating acute cholecystitis. Although the incidence of postoperative infections in laparoscopic cholecystectomy is low, serious postoperative surgical site infections are still reported. Hepatic abscesses, particularly fungal, can occur post-cholecystectomy leading to significant mortality and morbidity. We report a case of a 58-year-old female who underwent laparoscopic cholecystectomy and subsequently developed fever, jaundice, and right upper quadrant pain. Laboratory results showed deranged liver function tests with raised inflammatory markers. Radiographic investigations, including CT and MRI, revealed an irregular hilar lesion with periportal changes suggestive of an abscess with portal vein thrombosis. Histopathological examination of the biopsy obtained from the hilar lesion showed a fungal hepatic infection, and particularly conidiobolomycosis. To our best knowledge, this is the first case that reports this fungal infection as a complication of laparoscopic cholecystectomy. The patient was managed with a combination of intravenous antibiotics and antifungals, which yielded mild improvement. Unfortunately, the patient decided to leave the hospital against medical advice, limiting the information on the disease course. [ABSTRACT FROM AUTHOR]

Margarita Dudina,1,2 Kirstine Kobberøe Søgaard,1,3 Søren Schou Olesen,3,4 Hans Linde Nielsen1,3 1Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, 9000, Denmark; 2Department of Clinical Microbiology, Aarhus University Hospital, Aarhus N, 8200, Denmark; 3Department of Clinical Medicine, Aalborg University, Aalborg, 9000, Denmark; 4Centre for Pancreatic Diseases, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, 9000, DenmarkCorrespondence: Margarita Dudina, Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N, 8200, Denmark, Email mardud@rm.dkPurpose: Routinely collected clinical data are a valuable resource for epidemiological research in infectious diseases. We examined the validity of the ICD-10 diagnosis code K75.0 for pyogenic liver abscess (PLA) from hospital discharge registries.Patients and Methods: This validation study was conducted in the North Denmark Region, using data from Aalborg University Hospital and the North Denmark Regional Hospital, along with their smaller regional satellite hospitals. The study period extended from January 1, 2010, to June 30, 2022, covering a catchment population of approximately 590,000 inhabitants. We identified patients with a first diagnosis (primary or secondary) of PLA (ICD-10 code K75.0) recorded in the Danish National Patient Registry and estimated the positive predictive value (PPV) of the PLA diagnosis using medical records as the reference standard. Subanalyses of PPV were conducted based on the department setting (emergency, medical, or surgical).Results: A total of 297 patients received an ICD-10 diagnosis code of K75.0 during the study period. Five (2.0%) patients were excluded due to initial hospitalization outside the North Denmark Region, and 67 (23%) were misclassified. The overall PPV for the K75.0 diagnosis code during the study period was 77% (95% CI: 72– 82%). The highest PPV, 88% (95% CI: 81– 93%), was observed in patients diagnosed in medical departments, while the lowest PPV, 56% (95% CI: 30– 80%), was observed in patients diagnosed in emergency wards. The PPV for surgical departments was 69% (95% CI: 61– 77%).Conclusion: The overall PPV of the ICD-10 diagnosis code K75.0 for PLA was 77%. Variability in PPVs across departments suggested differences in diagnostic accuracy, with medical departments demonstrating the highest PPV.Keywords: pyogenic liver abscess, hepatic abscess, epidemiology, validation, positive predictive value

Aims Methods and Results Conclusions Hepatic inflammatory pseudotumours (IPTs) are nonneoplastic hepatic masses characterized by variably fibroblastic stroma and inflammatory infiltrate, hypothesized to arise as part of a response to infection or prior surgery. The aim of this study was to evaluate the clinicopathologic features and outcomes of biopsy‐proven hepatic IPT as well as other cases with IPT‐like histologic features.A database search at our institution identified cases with a pathologic diagnosis of hepatic IPT (n = 80) between 2000 and 2023. Histologic features (stromal quality, inflammatory cell components, granulomas, and necrosis) were evaluated. Past medical and surgical history, microbiologic studies, and outcomes were reviewed retrospectively. Patients frequently had a past medical history of malignancy (34%), biliary disease (15%), or prior intraabdominal surgery (24%), and often presented with multifocal hepatic lesions (36%). Variable inflammatory backgrounds were present, including histiocytic (36%), lymphoplasmacytic (34%), or neutrophilic (24%). Specific organisms were identified in 15% of cases, most commonly Klebsiella and Staphylococcus species. Most patients with available clinical follow‐up demonstrated radiologic resolution and/or had repeat negative biopsy; a minority of patients (8%) were subsequently diagnosed with neoplastic hepatic lesions. No significant association was seen between histologic features and the subsequent clinical or pathologic diagnosis of hepatic neoplastic lesions.Hepatic IPT is a heterogeneous entity that can present in a variety of clinical scenarios and show a wide morphologic spectrum. These lesions often regress spontaneously or with antibiotics. A subset of cases with hepatic IPT‐like histologic features were subsequently diagnosed with malignancy, emphasizing the need for continued follow‐up and repeat biopsy depending on clinical and radiologic features. [ABSTRACT FROM AUTHOR]

Syphilis is a sexually transmitted infection caused by Treponema pallidum. It progresses in phases and undiagnosed disease can cause considerable morbidity. Tertiary syphilis causes the formation of gummas. Liver involvement is rarely described and usually limited to transaminase elevation during primary syphilis. We present a case of tertiary syphilis in an HIV patient. Microbiological, clinical, and radiological information were retrieved from the patient's record. Gummatous syphilis is rarely described in the literature, and practicing physicians should be aware of its existence and include this manifestation in the differential diagnosis of patients with a positive serology and focal liver lesions. [ABSTRACT FROM AUTHOR]

Serum levels of the tumor marker CA 19–9 are widely utilized in the diagnosis and monitoring pancreatic and biliary malignancies. However, serum levels of CA 19–9 have also been reportedly elevated in non-malignant conditions. Here, we present the rare case of a 65-year-old woman with a history of gallbladder malignancy who was found to have a new hepatic lesion on surveillance CT with an associated elevation in CA 19–9 to 5,866 U/mL. Drainage of the lesion and treatment with antibiotics resulted in a rapid decline in CA 19–9 levels, indicating that the elevation in CA 19–9 was due to a benign hepatic lesion. We review eight similar reported cases of CA 19–9 elevations due to benign hepatic abscesses, thereby highlighting a need to interpret the tumor marker with caution.

Case Presentation: A 92-year-old female with past medical history of hypertension presented to the emergency department with pain in her right shoulder, right flank, and right upper quadrant of her abdomen. Point-of-care ultrasound (POCUS) and computed tomography imaging showed concerns for multiple large hepatic abscesses. Percutaneous drainage removed 240 milliliters of purulent fluid that identified Fusobacterium nucleatum, a rare cause of pyogenic liver abscess.Discussion: Emergency physicians should keep hepatic abscess on their differential for right upper quadrant abdominal pain and can use POCUS for expeditious diagnosis.

The highest frequency of liver abscesses in our environment is, by far, of ethyl ambience, followed by those caused by bacterial agents; on the other hand, the clinical cure, lacking its symptomatology and sinology, makes it difficult to reach the etiological diagnosis. Intestinal parasites are the most common infectious agents in humans. It is estimated that a third of the world's population has a parasitic infection; about 450 million human beings will develop the disease, and a greater burden of disease occurs in children in low-income countries. Ascariasis is caused by the nematode Ascaris lumbricoides, the most frequent helminth infection among humans. It is one of the considered geohelminths that already requires a part of its biological cycle of passing through the earth. So, it is important to have a history of geophagy. It is spread by the faecal-oral route; therefore, its presence is greater in developing tropical and subtropical countries due to high humidity, inadequate hygiene and sanitation conditions. We report the case of a 4-year-old preschool female 4 months old with a hepatic abscess due to Ascaris lumbricoides. The etiological diagnosis was made in the aspirant fluid by a trans-diaphragmatic liver puncture. Eggs of the agent were identified in the liquid obtained, and in the faecal matter, serological studies resulted in positive titres using immunodiffusion and indirect haemagglutination. Medical management based on Albendazole was indicated with good tolerance and response to treatment, and discharged in good condition, then subsequently seen in the outpatient consultation at 6 and 12 months if there is an apparent alteration. Cases of liver abscess caused by this helminth are rare, which motivates us to communicate the present. [ABSTRACT FROM AUTHOR]

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Pylephlebitis, a septic thrombophlebitis of the portal vein, is an uncommon but serious complication following an abdominal site of infection, most frequently diverticulitis or appendicitis. It has a high mortality rate, yet it commonly presents with unspecific abdominal complaints and fever, making diagnosis by clinical and laboratory examinations alone, impossible. This report highlights the extensive computed tomography (CT) findings of pylephlebitis with multiple hepatic abscesses thought to be secondary to diverticulitis, in a patient presenting with septic shock. Radiological characteristics differentiating the liver lesions from malignancy, and showing the ascending pathway of vascular involvement from the inferior mesenteric vein to portal veins is presented, as well as the search for the primary site of infection. Recognizing and understanding the imaging findings in pylephlebitis is crucial for diagnosis and avoiding delay of appropriate treatment for this otherwise often fatal condition.

Accidental ingestion of fish bones can potentially lead to serious complications like perforation of the alimentary tract and the formation of abscesses in adjacent organs. Prompt and accurate diagnosis of the etiology of hepatic abscesses is critical to prevent clinical deterioration and poor outcomes. Notably, fish bones can be subtle in imaging studies and erroneously interpreted as calcifications, vessels, or artifacts potentially delaying diagnosis and management. Further complicating medical management, fish bones can be seeded with oral microflora which may not be effectively targeted by empiric antibiotics. Patients presenting with an occult hepatic abscess often have repeated visits to the emergency department with vague symptomology and abdominal pain without recollection of any precipitating events. In this case report, a multidisciplinary approach, including a high index of suspicion applied to CT imaging, was vital in identifying a foreign body within an abscess localized between the greater curvature of the stomach and left liver lobe. The foreign body, mimicking an intraperitoneal calcification, was a fish bone that had transmigrated through the stomach wall into the liver lobe. Once identified, definitive treatment included laparoscopic drainage of the abscess, extraction of the foreign body, and coverage with broad-spectrum antibiotics.

Anatomical variations of the biliary tree pose diagnostic and treatment challenges. While most are harmless and often discovered incidentally during procedures, some can lead to clinical issues and biliary complications, making knowledge of these variants crucial to prevent surgical mishaps. Here, we present an unusual and clinically significant case. A 61-year-old man is admitted to the hospital with epigastric pain and diagnosis of pancreatitis of biliary origin and intermediate risk of choledocholithiasis. Magnetic resonance cholangiopancreatography (MRCP) reported hepatolithiasis and choledocholithiasis, whereas endoscopic retrograde cholangiopancreatography showed cystic drain of the right hepatic duct. One month later the patient presented again to the emergency room with increasing abdominal pain and a computed tomography that demonstrated the presence of hepatic abscess and acute cholecystitis. The patient underwent percutaneous drain abscess and a subtotal laparoscopic cholecystectomy. Biliary anatomical variants present challenges on the diagnostic investigations, interventional and surgical procedures, understanding the possible complications is essential. [ABSTRACT FROM AUTHOR]

We report a case of multiple, giant, polymicrobial pyogenic liver abscesses that developed within 3 months in a patient with a recent pancreatic cancer diagnosis. He presented with fatigue, abdominal distension, abdominal pain, dyspnea, and lower extremity edema and was treated with intravenous antibiotics and percutaneous hepatic abscess catheter placement. Abscess fluid cultures were polymicrobial. Unfortunately, he developed septic shock with bacteremia and multiorgan failure and died after 6 days of hospitalization. Pyogenic liver abscesses are increasingly common in the United States, especially those associated with malignancy.

Abstract Background Pyogenic liver abscess is a rare condition in children especially in early infancy. The diagnosis requires a high index of suspicion and treatment has to be aggressive to avoid fatality. There is a rarity of reports of the condition in infancy in the African population. Thus, we report a case of the hepatic abscess with documented hypergammaglobulinemia in a young infant seen at the Lagos University Teaching hospital. Case presentation We describe the case of a 38-day-old female infant who presented with 4 weeks history of fever and 2 weeks history of progressive abdominal distension. At the onset of illness abdominal ultrasound suggested hepatic abscess and abdominal CT scan confirmed multiple loculated collections in 3 segments of the liver. Patient had drainage of the abscess and additional investigations revealed hypergammaglobulinemia (IgM, IgG, and IgE) in the patient. She completed 6 weeks of antibiotics and made significant clinical improvement. Conclusions Pyogenic liver abscess should be considered in the differential diagnosis of an infant with pyrexia with abdominal swelling, even in the absence of well-established risk factors. A high index of suspicion for underlying primary immunodeficiency is important when the condition is diagnosed in early infancy.

Introduction: This article discusses a case study involving a unique occurrence of a hepatic abscess caused by the presence of an ingested foreign body. Hepatic abscesses, characterized by pus accumulation within liver tissue, often result from various infections, with some cases having unidentified origins. Case presentation: This study focuses on a 75-year-old man who presented at an emergency department with persistent pain in the right upper abdomen and fever for ten days. Diagnostic tests revealed a low-density, multiloculated mass in the liver and a hyperdense linear structure near the duodenum, indicating a hepatic abscess originating from duodenal perforation due to a foreign body that had migrated from ingestion. The patient underwent antibiotic treatment and a surgical procedure involving laparotomy to extract the foreign object and drain the abscess. Conclusion: this case study underscores the rare occurrence of hepatic abscesses caused by ingested foreign bodies. Swift and accurate diagnosis, along with appropriate treatment involving foreign body removal and abscess drainage, are pivotal for favorable patient outcomes. The choice of treatment strategy impacts hospital stay duration, and understanding potential complications from foreign body ingestion enhances patient management and care.

Coccidioidomycosis is an infection caused by inhalation of arthroconidia of Coccidioides. Forty percent of patients will develop mild and self-limited respiratory infection, and a small fraction of these individuals will develop extrapulmonary disseminated disease. This is the case of a patient with a known history of disseminated coccidioidomycosis, who initially presented for symptoms of persistent pneumonia. On evaluation, the patient was found to have a hepatic abscess for which he underwent percutaneous drainage. Culture grew Coccidioides immitis, and the patient was treated with systemic antifungal. This is a rare case of disseminated coccidioidomycosis in the liver.

Background: Pyogenic liver abscess is a rare condition in children especially in early infancy. The diagnosis requires a high index of suspicion and treatment has to be aggressive to avoid fatality. There is a rarity of reports of the condition in infancy in the African population. Thus, we report a case of the hepatic abscess with documented hypergammaglobulinemia in a young infant seen at the Lagos University Teaching hospital. Case presentation: We describe the case of a 38-day-old female infant who presented with 4 weeks history of fever and 2 weeks history of progressive abdominal distension. At the onset of illness abdominal ultrasound suggested hepatic abscess and abdominal CT scan confirmed multiple loculated collections in 3 segments of the liver. Patient had drainage of the abscess and additional investigations revealed hypergammaglobulinemia (IgM, IgG, and IgE) in the patient. She completed 6 weeks of antibiotics and made significant clinical improvement. Conclusions: Pyogenic liver abscess should be considered in the differential diagnosis of an infant with pyrexia with abdominal swelling, even in the absence of well-established risk factors. A high index of suspicion for underlying primary immunodeficiency is important when the condition is diagnosed in early infancy. [ABSTRACT FROM AUTHOR]

Background: Liver abscess is one of the hepatobiliary manifestations of inflammatory bowel disease (IBD) that has been scarcely described in the literature. Objectives: To conduct a scoping review to provide a detailed description of the occurrence of hepatic abscess in patients with IBD and summarize the observed clinical features. Methodology: Searches were carried out using relevant keywords in Medline (via PubMed) and Web of Science from inception until June 13, 2022. Only articles that reported the occurrence of hepatic abscess in patients with IBD were included. Results: Forty-eight publications (40 case reports and 8 case series) were included, representing 73 patients with IBD who were radiologically or intraoperatively diagnosed with hepatic abscess. Patients with Crohn's disease were more predisposed to developing hepatic abscess than patients with ulcerative colitis (79.5% vs. 20.5%, respectively). Furthermore, pyogenic liver abscess was found to be more prevalent (57.9%) compared with aseptic (38.7%) and amebic (3.2%) abscesses. No clear relation was found between death or prolonged hospital stay in terms of the clinical presentation or management plan, as mortality was reported in different age groups with different managements. Conclusion: To date, there is no consensus regarding the appropriate management of hepatic abscess as an extraintestinal manifestation of IBD. However, the condition shares several features with liver abscess diagnosed among the general population. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is a common disease, especially in low-income countries, with a varied clinical spectrum involving multiple organs. Although liver abscess can be seen in 70% of patients with miliary tuberculosis, isolated tuberculous liver abscess (ILTA) is rare in immunocompetent children. Liver involvement, though seen in up to 70% of patients as a part of miliary TB, isolated tuberculous liver abscess (ITLA) is rare in 13 children. Objective: The present systematic review focuses on demographic parameters, clinical presentations, duration of antitubercular treatment, and the need for surgical intervention and recurrence in children with tuberculous liver abscess. Methods: A comprehensive search was done in major databases PubMed and Google Scholar using defined search terms encompassing case reports or case series on isolated tubercular liver abscess in children. The identified reports underwent screening by three different authors for inclusion and exclusion criteria. Results: The median (interquartile range [IQR]) age of presentation was 9.5 (6.5) years, with a slightly higher prevalence in females (59%). The most common presenting symptom was fever (95%), followed by abdominal pain (68%). Hepatomegaly was seen in 90% of cases and jaundice in 16%. The median (IQR) duration of antitubercular treatment was 6 (4) months and surgical intervention was required for 14 (63%) children. The resolution time of the ITLA varied across the children, with a median (IQR) time being 2 (7) months. Conclusion: Pediatric tubercular liver abscess requires a high index of suspicion, particularly in endemic countries like India. Children with liver abscess should be evaluated for TB, if response to initial management is poor. Early diagnosis and prompt treatment with systemic antitubercular treatment are associated with a favorable outcome.

Background: Liver abscess is one of the hepatobiliary manifestations of inflammatory bowel disease (IBD) that has been scarcely described in the literature. Objectives: To conduct a scoping review to provide a detailed description of the occurrence of hepatic abscess in patients with IBD and summarize the observed clinical features. Methodology: Searches were carried out using relevant keywords in Medline (via PubMed) and Web of Science from inception until June 13, 2022. Only articles that reported the occurrence of hepatic abscess in patients with IBD were included. Results: Forty-eight publications (40 case reports and 8 case series) were included, representing 73 patients with IBD who were radiologically or intraoperatively diagnosed with hepatic abscess. Patients with Crohn's disease were more predisposed to developing hepatic abscess than patients with ulcerative colitis (79.5% vs. 20.5%, respectively). Furthermore, pyogenic liver abscess was found to be more prevalent (57.9%) compared with aseptic (38.7%) and amebic (3.2%) abscesses. No clear relation was found between death or prolonged hospital stay in terms of the clinical presentation or management plan, as mortality was reported in different age groups with different managements. Conclusion: To date, there is no consensus regarding the appropriate management of hepatic abscess as an extraintestinal manifestation of IBD. However, the condition shares several features with liver abscess diagnosed among the general population.

Case summary: An 8-year-old male neutered domestic shorthair cat presented collapsed and was subsequently diagnosed with a pericardial effusion based on ultrasound imaging. A laboratory analysis of pericardial fluid revealed a septic pericardial effusion and further diagnostics, including abdominal ultrasound and fluid analysis, revealed a concurrent hepatic abscess. Bacterial isolation and identification from both septic foci revealed Escherichia coli. Therapeutic measures included a combination of medical and surgical intervention, the latter including a pericardiectomy, cholecystectomy, liver lobectomy and splenectomy. Relevance and novel information: Septic pericarditis is one of the least reported causes of feline pericardial effusion. This case report describes bacterial pericarditis in a cat, suspected to be derived from a hepatic abscess via haematological spread. In this case, a favourable response was achieved with both surgical and medical management. [ABSTRACT FROM AUTHOR]

This article reports on a case study of a 46-year-old woman with multiple comorbidities who developed liver abscesses caused by a vancomycin- and linezolid-resistant strain of Enterococcus faecium (EF-PD-1305). The patient was treated with oritavancin, an off-label use of the drug, and showed favorable clinical outcomes with complete resolution of the abscesses. Molecular characterization and sequencing of the EF-PD-1305 isolate revealed a variety of resistance genes and mutations associated with antibiotic resistance. This case highlights the potential efficacy of oritavancin as a treatment option for complicated cases of vancomycin- and linezolid-resistant Enterococcus infections. [Extracted from the article]

Fasciola hepatica is a trematode causing acute and chronic infection. A 33-year-old Canadian woman with eosinophilic liver abscesses and no relevant travel was diagnosed with F hepatica infection. F hepatica is reported in livestock in Alberta. This is the first case of locally acquired fascioliasis in Canada in >100 years. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections are often implicated in the causation of liver abscesses, and the transmission occurs via the vascular route. We report a rare case of abscess of the liver, Stenotrophomonas maltophilia being the etiological agent, in a 25-year-old female residing in Lucknow, India. S. maltophilia is a common nosocomial pathogen responsible for causing pneumonia, bacteremia, meningitis, endocarditis, gastrointestinal, ocular, skin, soft tissue, bone, joint, urinary tract infections, and even septic shock, especially in intensive care units. However, very few case reports are from India and globally, highlighting it as a pathogen in a liver abscess case. Hence this study is relevant in the context of providing case details that can help clinicians and microbiologists to suspect and diagnose more such cases that might be missing in history.

Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease, and estimates suggest a gradual increase in the incidence during the last decades. The primary aim of this study was to report the incidence, trend and aetiology of PLA during a decade in Southern Sweden. This was a population-based observational cohort study between 2011 and 2020 in Skåne, Southern Sweden. Data were retrieved from the Swedish National Board of Health and Welfare for all individuals diagnosed with liver abscess (K750) according to ICD-10 (International Statistical Classification of Diseases, 10th revision). A total of 456 episodes of PLA occurred in 364 patients during the study period. The median age of the first PLA episode was 71 years (range 3–97) and 57% (n = 206) were men. The mean incidence of all patients was 3.4/100,000 person-years (range 1.8–5.2). The incidence increased almost three times, from 1.8/100,000 person-years in 2011 to 5.2/100,000 person-years in 2020. Streptococcus species, Escherichia coli and Klebsiella species accounted for the vast majority of both mono- and polymicrobial findings in both blood and local abscess cultures. 16s rDNA added information about aetiology in 37% of episodes. The incidence of PLA increased during the study period, and Streptococcus spp., Klebsiella spp. and E. coli dominated both blood and local cultures. Despite antimicrobial therapy, pathogens could be found in local abscess cultures several weeks into treatment. Increased use of 16s rDNA in the management of PLA could be beneficial. [ABSTRACT FROM AUTHOR]

Introduction: Aseptic hepatic abscesses are a highly uncommon phenomenon and even more rare in the spectrum of extraintestinal manifestations of inflammatory bowel disease. Part of the spectrum of "neutrophilic disease," both the pathogenesis and the optimal management of these aseptic abscesses remain unclear. In the context of inflammatory bowel disease, sometimes these abscesses appear despite normal endoscopic findings., Case Presentation: We describe a highly uncommon case of aseptic hepatic abscess formation in a patient with inflammatory bowel disease., Conclusion: In doing so, we investigated the concept of "aseptic abscess syndrome" as it relates to similar autoimmune conditions., Competing Interests: The authors have no conflicts of interest to declare., (© 2025 The Author(s). Published by S. Karger AG, Basel.)

Introduction: Liver abscess is a common clinical condition caused by bacterial, fungal or parasitic infections, usually due to immunosuppression. In contrast, secondary liver abscesses are caused by specific factors such as foreign bodies, tumours, or appendicitis., Methods: We admitted a patient with secondary liver abscess and found an intrahepatic foreign body after interventional drainage. Initially, a foreign body of medical origin was suspected, but after a multidisciplinary consultation, it was determined to be caused by a foodborne foreign body. Laparoscopic surgery was then chosen as the treatment., Result: The liver abscess was caused by an alimentary foreign body, and the intrahepatic foreign body was identified as a fish bone measuring approximately 2.5 cm in length., Discussion: Upon diagnosing either primary or secondary liver abscess, aggressive treatment of the abscess focus is essential. However, in cases of secondary liver abscess, addressing and removing the underlying cause is necessary for complete resolution. For patients with a previously healthy liver, comprehensive history-taking is crucial, and imaging studies play a significant role in diagnosis and treatment. Clinicians and radiologists should be vigilant for the possibility of foreign bodies, tumours, or unexpected intra-abdominal inflammation, regardless of the patient's history. When dealing with food-borne foreign bodies, endoscopic intervention should be considered first, followed by laparoscopy, and as a last resort, open surgery., Conclusion: The diagnosis and treatment of liver abscess in clinical practice require a complete medical history and thorough imaging examinations. Ultrasound, as the initial imaging modality, allows real-time and dynamic observation of lesions. It is essential for ultrasonologists to consider the possibility of foreign body-induced liver abscess when diagnosing patients with liver abscess., Competing Interests: The authors have no conflicts of interest to declare., (© 2025 Australasian Society for Ultrasound in Medicine.)

Background: Hepatic eosinophilic pseudotumor (HEPT) is a rare condition that mimics malignant hepatic tumors, posing significant diagnostic challenges. This case report highlights the importance of considering parasitic infections like Fasciola hepatica ( F. hepatica ) in the differential diagnosis of hepatic masses, especially in endemic regions, to prevent unnecessary interventions., Case Summary: A 40-year-old female presented with a 1-month history of epigastric pain and significant weight loss. Imaging revealed a hepatic mass, initially misdiagnosed as intrahepatic cholangiocarcinoma. Laboratory results showed marked eosinophilia, and histopathological examination confirmed significant eosinophilic infiltration without malignancy. Serological testing identified F. hepatica infection. The patient was treated with a single dose of triclabendazole, leading to complete symptom resolution and normalization of hepatic imaging findings within days., Conclusion: HEPT due to F. hepatica can closely mimic malignancy; timely antiparasitic treatment is crucial for resolution., Competing Interests: Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose., (©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.)

We present the case of a 75-year-old woman with a history of laparoscopic cholecystectomy, which was converted to an open procedure due to intraoperative hemorrhage. Two weeks later, she underwent reintervention to address a subhepatic hematoma. Over a follow-up period of 19 months, she remained symptomatic, experiencing persistent purulent discharge from the surgical drain site, mild fever, and abdominal pain. A CT scan revealed a gossypiboma, and following a failed surgical exploration, the patient was referred to a specialized center. A fourth surgical exploration identified an abscess in the abdominal wall and multiple abscesses within the liver, one of which contained an intrahepatic gossypiboma. Postoperative care involved a levofloxacin-based antibiotic regimen, leading to a favorable clinical outcome. This case represents an instance of a gossypiboma becoming fully internalized within the hepatic parenchyma following non-traumatic surgery., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Meza-Bosquez et al.)

Liver transplant may be necessary to manage infectious complications from severe structural biliary disease. In this report, we describe a 71-year-old woman with history of coil-embolized hepatic artery pseudoaneurysm who subsequently developed biliary obstruction resulting from coil erosion into the common hepatic duct. Resultant complications included recurrent cholangitis, bacteremia, and numerous hepatic abscesses. Because of lack of improvement with medical management, the patient underwent liver transplantation and coil removal as the definitive treatment modality. Altogether, this report explores a unique case of liver transplantation as source control for a patient with an active disseminated infection., (© 2025 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Clostridium perfringens  ( C. perfringens )   is a rare cause of febrile neutropenia in patients with acute leukemia, and only a few case reports are published in the literature. The peculiar presentation of this clostridial sepsis, with the formation of gaseous liver abscess and toxin-associated intravascular hemolysis, can suggest the diagnosis in immunocompromised patients and prompt immediate treatment. Early identification of these clinical features may be essential to prevent the accelerated and aggressive course of this infection with a very high mortality rate. Here we report the case of a patient with mixed-phenotype acute leukemia who developed C. perfringens sepsis in the context of profound chemotherapy-induced neutropenia., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2025, Baptista et al.)

Abstract Background Clostridium perfringens sepsis associated with massive intravascular hemolysis has an extremely poor prognosis. We here report a case of C. perfringens sepsis associated with massive intravascular hemolysis that developed secondary to a post-pancreaticoduodenectomy (PD) hepatic abscess. Case presentation A 70-year-old man with Type 2 diabetes underwent PD for an ampulla of Vater carcinoma. His postoperative course was uneventful. He was discharged on the 16th post-operative day (POD 16) after confirming no major abnormalities on abdominal contrast computed tomography (CT) on POD 14 or laboratory results on POD 16. Two days after discharge, he was readmitted because of fever and chills. Laboratory tests showed only a mild inflammatory reaction (white blood cell count, 11,980/mm3; C-reactive protein, 2.07 mg/dL). Abdominal CT showed an irregular, approximately 20-mm diameter, low-density area in the liver S6 region that had not been seen on a recent previous scan. We initially suspected postoperative cholangitis associated with biliary reconstruction and started empirical treatment with sulbactam/ampicillin after drawing blood for culture. Eight hours after admission, he developed septic shock with body temperature 40.0 ℃ and blood pressure 70/40 mm Hg. Laboratory findings showed a severe inflammatory reaction, severe anemia, and massive hemolysis (white blood cell count, 37,400/mm3; hemoglobin, 7.7 g/dL; total bilirubin, 8.05 mg/dL; direct bilirubin, 2.66 mg/dL; and lactate dehydrogenase, 1686 U/L). Hemoglobinuria was noted in the urinary catheter output. Repeat CT 9 h after admission showed the low-density area in S6 had become a gas-forming abscess. C. perfringens sepsis was strongly suspected on the basis of these findings and the abscess was drained percutaneously immediately after its diagnosis. His vital signs improved dramatically and he recovered within 24 h. Blood and abscess cultures grew C. perfringens 4 days after admission, leading to a definitive diagnosis of C. perfringens sepsis associated with massive intravascular hemolysis. He was discharged 18 days after admission. His sepsis has not recurred. Conclusions Clostridium perfringens infection should be considered in patients who have undergone PD and present with gas-forming hepatic abscesses and/or sepsis associated with intravascular hemolysis. Prompt aggressive treatment is crucial, because C. perfringens infections can cause death within hours.

Neonatal hepatic abscess (NHA) is a fatal condition in neonates. NHA can be caused by many organisms including bacteria, parasites, and fungi. Fungal NHA is a rare but troublesome cause in terms of diagnosis and treatment. We present three cases of fungal NHA caused by Candida. In these three cases, different underlying problems associated with NHA had been found.

Yersinia pseudotuberculosis is a rare Gram‐negative bacillus that cause enterocolitis and terminal ileitis. We report the first Danish case with Y. pseudotuberculosis multiple pyogenic liver abscess presenting with 6 weeks intermittently fever, fatigue, and weight loss. The patient was successfully treated with percutaneous drainage and intravenous piperacillin/tazobactam and oral ciprofloxacin. This is the first Danish case with Y. pseudotuberculosis pyogenic liver abscess, diagnosed in the left lobe by a CT‐scan. The patient was successfully treated with percutaneous drainage and intravenous piperacillin/tazobactam and oral ciprofloxacin. [ABSTRACT FROM AUTHOR]

Background: Liver abscesses are localized collections of necrotic inflammatory tissue caused by bacterial, parasitic or fungal agents. These abscesses are usually suspected clinically in cases having fever and tender hepatomegaly. The diagnosis is usually confirmed on the basis of imaging such as ultrasound and computerised tomography. Management includes antimicrobial agents and drainage of abscess. Percutaneous drainage of abscess is done using needle aspiration or catheter drainage. Aims and Objective: The main aim of the study was to evaluate the role of pigtail catheterization drainage procedure as a treatment option in cases of liver abscess. Materials and Methods: It was a prospective study conducted ata tertiary care medical college. Fifty patients having hepatic abscess were included in this study over a period of one year from August 2018 to September 2019 on the basis of a predefined inclusion and exclusion criteria. These patients underwent pigtail catheterization of liver abscess as a treatment. The demographic characteristics, hepatic lobe involvement, offending organisms and complications were studies in these patients. Results: Out of 50 patients 35 were male and 15 were femalewith a M: F ratio of 1:0.42. The age ranged from 4 years to 92 years. The mean age of the studied cases was found to be 38.64 +/- 18.17 years. Right lobe was involved in predominant cases. most common individual organism involved in hepatic abscess formation was klebsiella (30%) followed by streptococcus (20%) and E-coli (8%) organisms. Seven patients developed procedure related complications out of which 5 patients had catheter dislodgment requiring repositioning of catheter 1 patient developed pus discharge from catheter site and remaining 1 patient developed subcapsular hematoma. Conclusion: Percutaneous image guided pigtail catheter of liver abscess is an effective minimal procedure as a treatment option for liver abscess with high success rate with no mortality related to procedure.

Pyogenic liver abscess (PLA) is a common cause of hepatobiliary sepsis. Klebsiella pneumoniae (KP) is the most common organism causing PLA. Evidence is scarce on the demographics, radiological findings, and outcomes of KPPLA versus non-KPPLA (N-KPPLA). PubMed, Embase, The Cochrane Library, and Scopus were systematically searched until 14 May 2022 for studies comparing KPPLA and N-KPPLA. Exclusion criteria were single-arm studies. Primary outcomes were mortality (30-day/in-hospital) and metastatic complications. There were 16 studies, including 5127 patients (KPPLA n = 3305, N-KPPLA n = 1822). Patients with KPPLA were younger (mean difference: −2.04 years, p = 0.02). History of hepatobiliary disease (Odds ratio (OR) 0.30, 95% CI: 0.20, 0.46) and malignancy (OR 0.26, 95% CI: 0.16, 0.42) were less common in KPPLA. KPPLA was associated with lower incidence of multiple abscesses (OR 0.52, 95% CI: 0.35, 0.76, p < 0.001) and bilobar abscesses (OR 0.60, 95% CI: 0.49, 0.74, p < 0.001). KPPLA has higher overall metastatic complications (KPPLA 9.7% vs. N-KPPLA 4.8%, OR 3.16, 95% CI: 2.00, 4.99, p < 0.001), but lower mortality (KPPLA 3.9% vs. N-KPPLA 7.6%, OR 0.51, 95% CI: 0.34, 0.78, p < 0.001). Trial sequential analysis showed conclusive evidence that KPPLA has lower mortality than N-KPPLA. In conclusion, KPPLA has lower mortality than N-KPPLA. [ABSTRACT FROM AUTHOR]

Inflammatory myofibroblastic tumors have a wide spectrum of biological behaviour and are composed of inflammatory cells and myofibroblastic spindle cells. Tumors may infrequently involve the liver. Imaging findings are non-specific. Teaching Point: Radiologists should be familiar with inflammatory myofibroblastic tumors as a diagnostic consideration to avoid unnecessary surgery.