A 65-year-old male presented with chest and abdominal pain for three weeks. He endorsed a poor appetite and a weight loss of 16 kilograms in the last month. He denied fever, vomiting, diarrhea, and tarry stools and described having his usual bowel movements.
Vitals: BP 172/71; HR 127; T 35.9°C; O2 Sat 100%
General: In acute distress
Cardiovascular: Regular rate and rhythm; no murmur; bilateral upper extremity and lower extremity pulses palpable
Gastrointestinal: Soft; generalized tenderness, no abdominal masses, palpable subcutaneous emphysema
Complete blood count (CBC): WBC 31 x 10^3/mcl; Hgb 15 g/dl; Hct 49.1%; Plt 477 x 10^3/mcl
Basic metabolic panel (BMP): Na 130 mmol/L; K 5.6 mmol/L; Glucose 538 mg/dL
CRP: 42.6 mg/dL
Ketone body: 5.9 mmol/L
Venous blood gas (VBG): pH 6.967; pCO2 27.9 mmHg; pO2 45.8 mmHg; BE -24.7 mmol/L
Rupture of gas-forming pyogenic liver abscess complicated by necrotizing fasciitis. The most common pathogen is Klebsiella pneumoniae, and diabetes mellitus is the most common risk factor.
Treatment includes drainage, systemic antibiotic therapy, and emergent surgical intervention.
Take-Home Points
- Gas-forming pyogenic liver abscess is a rare but life-threatening disease. Consider it especially in the patient with abdominal pain with diabetes mellitus.
- Treatment includes not only drainage and systemic antibiotic therapy, but also emergent surgical intervention if complicated by necrotizing fasciitis.
- Chen CE, Shih YC. Monomicrobial Klebsiella pneumoniae Necrotizing Fasciitis With Liver Abscess: A Case Report and Literature Review. Ann Plast Surg. 2017 Mar;78(3 Suppl 2):S28-S31. doi: 10.1097/SAP.0000000000001001. PMID: 28177973.
- Cheng NC, Yu YC, Tai HC, Hsueh PR, Chang SC, Lai SY, Yi WC, Fang CT. Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis. Clin Infect Dis. 2012 Oct;55(7):930-9. doi: 10.1093/cid/cis565. Epub 2012 Jun 19. PMID: 22715175.
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