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Metallic cough and pyogenic liver abscess.

A Ala¹, H Safar-Aly, A Millar

¹Department of Gastroenterology, North Middlesex Hospital, London, UK. a.ala@rfc.ucl.ac.uk

European Journal of Gastroenterology & Hepatology

|August 17, 2001

Summary

A metallic cough can signal a hepatobronchial fistula, a rare complication of pyogenic liver abscesses. This case highlights the importance of recognizing this symptom for prompt diagnosis and effective treatment.

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Area of Science:

Gastroenterology and Hepatology
Pulmonology
Infectious Diseases

Background:

Pyogenic liver abscesses can present with unusual symptoms.
Diverticular disease and long-term steroid use are risk factors for complications.
Hepatobronchial fistula is a rare but serious complication of liver abscesses.

Observation:

A 78-year-old female with diverticular disease and polymyalgia rheumatica developed a pyogenic liver abscess.
The patient presented with a metallic cough, a potential indicator of fistula.
Radiology confirmed a fistulous communication between the liver abscess and the bronchus.

Findings:

The liver abscess was initially treated with antimicrobial therapy and percutaneous drainage.
The hepatobronchial fistula complicated the initial treatment course.

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Repeated interventions successfully resolved both the abscess and the fistula.

Implications:

A metallic cough in the context of a liver abscess warrants investigation for a hepatobronchial fistula.
Multimodal treatment including drainage and antimicrobials can be effective for complex cases.
Early recognition and management are crucial for favorable outcomes in hepatobronchial fistula.