ABSTRACT
Case Report : Liver Abscess in diabetic patients
Hotma Pebrina
Siloam Hospital Bangka Belitung (SHBB)
Background : The incidence of liver abscess, a rare but potentially lifethreatening infection, appears to be
increasing worldwide. The three major forms of liver abscess, classified by etiology, are as follows:
Pyogenic abscess, Amebic abscess and Fungal abscess. Liver abscess can cause fatal systemic infections,
especially in the case of combining high risk factors or underlying conditions, serious complications and
worse prognosis are more likely. Meanwhile, DM status may easier result in severe complications and
recurrent infection. In addition, poor-control of blood glucose may aggravate the situation and prognosis.
Case report : A 39-year old male, presents to the SHBB’s emergency department with right-sided upper
back and flank pain. On further history he reported having had approximately 1 month of intermittent
fevers, cough, abdominal pain, nausea and vomiting to malaise and weight loss. On physical examination
his vital signs included a blood pressure of 90/63 mmHg, a heart rate of 97 beats per minute, and a
respiratory rate of 20 breaths per minute. His temperature in the ED was 36.1°C. Oxygen (O2) saturation
was 98% on RA. The patient was alert, and appropriate with no signs of respiratory distress. His abdomen
was soft and non-tender but show hepatomegaly and right upper quadrant pain. The initial diagnostic test
ordered was a computed tomography (CT) of the abdomen demonstrated a hypodense lesion with an
intralesional air-fluid level in the right lobe of the liver. The abscess was about 10 cm. Bloodwork sent after
initial examination returned showing a WBC count of 15×103/uL, haemoglobyn of 8.3 g/dL, blood random
glucose of 415 mg/dL, HbA1c of 14.1%, total bilirubin of 14.6, direct bilirubin 0f 12.99, indirect bilirubin
of 1.07 and SGPT of 72 U/L. The patient was treated with 1 L of NS, 500 ml of PRC and started on IV
ceftriaxone and metronidazole. The patient was admitted to the operation room where he underwent
percutaneous drain placement.
Conclusion : Liver abscess is fortunately a relatively uncommon disease as it can be a difficult diagnosis to
make. The presenting complaints, physical findings and laboratory markers can be entirely variable as
illustrated by our patient. My case underlines the importance in keeping liver abscesses on the differential
diagnosis, especially in those patients with the risk factors described, like diabetes.
Keywords : Liver abscess, diabetes, air-fluid level.