Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report

Abstract

Background: Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care.

Case presentation: The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged.

Conclusion: Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.

Keywords: Diabetes mellitus; Emphysematous liver abscess; Gas-forming pyogenic liver abscesses.

Fig. 1

Gas was observed in the right subphrenic space on simple abdominal radiography (arrow)

Fig. 2

A hypoechoic lesion with indistinct boundaries was observed in the right hepatic lobe on abdominal ultrasound, and several hyperechoic findings suggestive of air were observed within this lesion (arrow)

Fig. 3

An abscess 5 cm in diameter was observed in the right hepatic lobe on abdominal computed tomography, within which gas-related fluid formation was detected (arrow). A cyst was observed in the left lobe

Fig. 4

Effluent drained from the abscess. Reddish-brown purulent effusion was observed