minocycline and Liver-Abscess

Hepatic actinomycosis is rare. We report an 86-year-old Japanese man with a 3-day history of high fever and anorexia who had an actinomycotic liver abscess complicated by disseminated intravascular coagulation (DIC). A definitive diagnosis was made when an Actinomyces species was cultured from aspirated pus. The clinical course was satisfactory. Treatment included prompt percutaneous drainage coupled with long-term intravenous administration of high-dose minocycline and piperacillin, combined with therapy for DIC. We reviewed 11 cases in Japan of Actinomyces involving the liver, including the case reported here. In most patients, there were no predisposing factors. Common symptoms and laboratory findings included fever, abdominal pain, leukocytosis, and elevated C-reactive protein. In 6 of the 11 patients a partial hepatectomy was performed because hepatic tumor was suspected. Five patients presented with a liver abscess. Hepatic actinomycosis should be considered in the differential diagnoses of pyogenic liver abscess and space-occupying lesions of the liver.

Topics: Actinomyces; Actinomycosis; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Disseminated Intravascular Coagulation; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infusions, Intravenous; Liver Abscess; Male; Middle Aged; Minocycline; Penicillins; Piperacillin; Tomography, X-Ray Computed

Topics: Ceftriaxone; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Laparoscopy; Liver Abscess; Microbial Sensitivity Tests; Middle Aged; Minocycline; Tigecycline

Fusobacterium necrophorum is a non-sporulating anaerobic gram negative bacillus and has traditionally been associated with Lemierre's syndrome. The authors report a 34-year-old male who presented to the emergency department with a week's history of dull epigastirc pain. Significant medical history included chronic pancreatitis secondary to alcohol use. The patient had radiological evidence of acute on chronic pancreatitis with thrombosis of the portal vein and multiple intrahepatic abscesses. CT-guided drainage of left upper quadrant revealed fluid collection in the pancreatic bed. The fluid culture grew F necrophorum and the patient was treated with tigecycline for 4 weeks. The patient improved symptomatically and his follow-up computerised axial tomography scan 2 months later showed resolving liver abscess, cavernous transformation of the portal vein and stable findings of chronic pancreatitis. This could represent an infection of the peripancreatic tissue with F necrophorum further leading to pylephlebitis.

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Minocycline; Pancreatitis; Portal Vein; Radiography; Tigecycline; Venous Thrombosis

Pyogenic liver abscesses are uncommon in clinical practice and are usually polymicrobial in nature, with members of the Enterobacteriacae family often implicated. This report describes the use of tigecycline to treat a liver abscess caused by methicillin-resistant Staphylococcus aureus, which was refractory to therapy with standard antimicrobials.

Topics: Anti-Bacterial Agents; Humans; Liver Abscess; Male; Methicillin Resistance; Middle Aged; Minocycline; Staphylococcal Infections; Staphylococcus aureus; Tigecycline; Tomography, X-Ray Computed

Topics: Adult; Drainage; Drug Therapy, Combination; Humans; Liver Abscess; Male; Methicillin Resistance; Minocycline; Povidone-Iodine; Staphylococcal Infections; Staphylococcus aureus