A Case Report of a Pyogenic Liver Abscess Caused by Fusobacterium Nucleatum in a Patient With Autosomal Dominant Polycystic Kidney Disease Undergoing Hemodialysis

• Published in: Therapeutic apheresis and dialysis 2008-02, Vol.12 (1), p.91-95
• Main Authors: Cigarrán, Secundino, Neches, Carmen, Lamas, José María, García‐Trio, Gerardo, Alonso, Mario, Saavedra, Jesus
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; Autosomal dominant polycystic kidney disease; Catheterization; Drainage; Fusobacterium Infections - etiology; Fusobacterium nucleatum; Fusobacterium nucleatum - isolation & purification; Hemodialysis; Humans; Liver Abscess, Pyogenic - etiology; Liver Abscess, Pyogenic - microbiology; Male; Metronidazole - therapeutic use; Middle Aged; Polycystic Kidney, Autosomal Dominant - complications; Polycystic Kidney, Autosomal Dominant - therapy; Pyogenic liver abscess; Remission Induction; Renal Dialysis
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/j.1744-9987.2007.00548.x

:  Pyogenic liver abscess (PLA) is a process with significant morbidity and mortality and is a rare complication in an aisled way in patients with autosomal dominant polycystic kidney disease (ADPKD). In addition to hepatic cyst infection, intracystic hemorrhage is another complication seen in ADPKD patients; however, the liver parenchyma itself remains normal. A PLA located in normal liver tissue in these kinds of patients has not been previously reported. Fusobacterium nucleatum is an anaerobic bacterium with rare involvement other than in periodontal infections. A 58‐year‐old Caucasian male, who was on hemodialysis treatment from July 2004 due to end‐stage renal disease secondary to ADPKD, was admitted with fever, rigor, chills, weakness, and abdominal pain of 10 days duration. During that time, ciprofloxacin 500 mg, twice daily, gentamycin 80 mg/48 h, and vancomycin 1 g/week, were prescribed, but treatment was interrupted by hospitalization. Physical examination on admission revealed that the patient had a fever of 39.8°C, pallor, chills, right upper quadrant abdominal pain, and hepatosplenomegaly. Abdominal ultrasound revealed a 5.3 cm diameter collection with irregular configuration located in the caudate lobe. Abdominal computed tomography (CT) showed a large multiloculated hepatic collection. The PLA was managed with antibiotics (metronidazole) and continuous catheter drainage (8Fr drainage catheters [Abocath‐T, Abbott, Sligo, Ireland]) into the abscess. Fluid culture was positive for F. nucleatum. Complete remission was obtained after 12 days without complications. We describe a PLA by F. nucleatum, in a very rare location in an ADPKD patient undergoing hemodialysis without complicated cysts, managed with antibiotics and percutaneous drainage with satisfactory resolution.