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Discussion:
We present the case of a young, healthy Singaporean man who developed pyogenic
liver abscesses (PLA) in the setting of appendicitis. Liver abscesses are most frequently
caused by biliary disease, but can be secondary to diverticulitis, appendicitis, perforated
ulcers or malignancies, and inflammatory bowel disease. PLA secondary to appendicitis
is rare, and most cases are associated with liver abscess formation following treatment
of a perforated, gangrenous, or phlegmonous appendicitis. Unique to this case is that the
appendix was only notable for a possible healing abscess; and further, that the
appendicitis and liver abscesses were diagnosed and managed concomitantly.
Historically, E. Coli has been the predominant cause of PLA, though Klebsiella
pneumoniae is emerging as the causative agent in a large proportion of liver abscess
cases in Asia, and a rapidly growing number in the United States as well. A common
risk factor for klebsiella liver abscesses is poorly controlled diabetes; other risk factors
include cholelithiasis, malignancy, and prior intra-abdominal surgery. Our patient did
not have any of these, and was younger than the majority of patients in the literature.
Klebsiella liver abscesses present with similar symptoms and lab abnormalities to other
bacterial liver abscesses, though with milder alkaline phosphatase and total bilirubin
elevations.
Conclusions:
Pyogenic liver abscesses can present in young otherwise healthy patients. It is important
to consider pyogenic liver abscess in the differential of sepsis of possible hepatobiliary
etiology, as urgent abscess drainage is often required.