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Address to: Dra Izabella Picinin Safe. Depto de Infectologia/FMT-HVD. Avenida Pedro Teixeira 25, Dom Pedro, 69040-000 Manaus, AM, Brasil.

Phone: 55 92 2127-3442

e-mail: [email protected] Received 26 February 2013 Accepted 25 June 2013

Images in Infectious Diseases

REFERENCES

A

Gas-forming pyogenic liver abscess

Izabella Picinin Safe

[1]

,

Kátia do Nascimento Couceiro

[2]

and Alessandra Galvão Martins

[1]

[1]. Departamento de Infectologia, Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM. [2]. Departamento de Clínica Médica, Fundação Hospital Adriano Jorge, Manaus, AM.

Gas-forming pyogenic liver abscess (GPLA) is an uncommon and potentially fatal disease that represents 7-24% of pyogenic liver abscess cases. Diabetes mellitus is a well-known risk factor, and the main etiological agent is Klebsiella pneumoniae. Escherichia coli is also associated with gas formation, particularly in the presence of biliary disorders. In South America, parasitic diseases have been described as predisposing factors for pyogenic liver abscesses and should be considered during etiological investigation. Clinical symptoms include fever and abdominal pain, but the presentation can be

non-specifi c. Diagnosis is facilitated by abdominal ultrasound and computed tomography scanning (Figure A); the presence of air is observed in less than 36% of chest roentgenograms, simulating pneumoperitoneum (Figure B). The fatality rate due to gas-forming abscesses is higher than that due to

non-1. Lee HL, Lee HC, Guo HR, Ko WC, Chen KW. Clinical signifi cance and mechanism of gas formation of pyogenic liver abscess due to Klebsiella pneumoniae. J Clin Microbiol 2004; 42:2783-2785.

2. Musso C, Pereira FE, Dettogni RV, Ferreira MA. Pyogenic liver abscess and schistosomiasis mansoni in the state of Espírito Santo. Rev Soc Bras Med Trop 1996; 29:359-362.

3. Chen SC, Tsai SJ, Lee YT, Yen CH, Huang CC, Lin DB, et al. Predictors of mortality in patients with pyogenic liver abscess. J Med 2008; 66:196-203.

gas-forming lesions. Other unfavorable prognostic factors are the presence of multidrug-resistant organisms, a high blood

urea nitrogen level and an APACHE II score ≥15 at admission.

Treatment includes hemodynamic support, antibiotic therapy and early drainage.

B

Revista da Sociedade Brasileira de Medicina Tropical 46(4):528, Jul-Aug, 2013

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