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Case Reports
. 2024 May;65(5):503-507.
doi: 10.1007/s00108-023-01593-z. Epub 2023 Oct 13.

[Acute abdomen-Rare cause in an 80-year-old female patient under immunosuppressive treatment]

[Article in German]
J Schlottmann  1 , S Miller  2 , C Scheurig-Münkler  3 , C Merkl  4 , T Weber  5 , S Eser  5 , A Fuchs  5 , H Messmann  5 , A Probst  5
Affiliations
Case Reports

[Acute abdomen-Rare cause in an 80-year-old female patient under immunosuppressive treatment]

[Article in German]
J Schlottmann et al. Inn Med (Heidelb). 2024 May.

Abstract
in English, German

An 80-year-old woman presented to the emergency department due to abdominal pain. She had a history of opportunistic pneumonia under the effects of immunosuppression after the diagnosis of autoimmune hepatitis. The imaging showed an omental cake formation and the suspicion of peritoneal carcinomatosis. The patient developed an acute abdomen during the hospital stay, followed by exploratory laparotomy. In the presence of extensive intra-abdominal abscess formation both surgically acquired material and blood culture revealed disseminated nocardiosis. The course was fatal due to fulminant septic shock.

Eine 80-jährige Frau stellte sich zur Abklärung abdomineller Schmerzen vor. Vorausgegangen war die Diagnosestellung einer Autoimmunhepatitis mit Einleitung einer immunsuppressiven Therapie und Auftritt zweier Pneumonien mit opportunistischen Erregern. Die Bildgebung erbrachte einen „omental cake“ mit Verdacht auf Peritonealkarzinose. Bei Auftritt eines akuten Abdomens erfolgte eine explorative Laparotomie, hierbei zeigten sich intraabdominelle Abszesse. Anhand von Blutkulturen und des intraoperativ gewonnenen Materials wurde eine disseminierte Nocardiose diagnostiziert. Die Patientin verstarb aufgrund einer fulminant verlaufenen Sepsis.

Keywords: Abdominal nocardiosis; Abscess; Autoimmune hepatitis; Nocardiosis; Omental cake.

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