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[Multiple liver abscesses in chronic granulomatosis].
H P Oswald1, H Fischer, G Menardi
1Universitäts-Kinderklinik, Innsbruck.
Padiatrie Und Padologie
|January 1, 1991
Summary
Chronic granulomatous disease in a child caused recurrent bacterial infections and liver abscesses. Successful treatment involved surgical drainage followed by chloramphenicol and long-term antibiotic chemoprophylaxis.
Area of Science:
- Pediatric Infectious Diseases
- Immunology
- Hepatology
Background:
- Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder characterized by defective phagocyte function.
- Recurrent, severe bacterial and fungal infections are hallmarks of CGD, often affecting organs like the liver.
- Liver abscesses represent a significant and potentially life-threatening complication in pediatric CGD patients.
Observation:
- A 3-year-old boy with CGD presented with recurrent bacterial infections culminating in multiple liver abscesses.
- Initial parenteral antibiotic therapy, despite appropriate drug selection for Staphylococcus, proved ineffective.
- Diagnosis was confirmed via the nitroblue-tetrazolium test and liver biopsy histology.
Findings:
- Surgical drainage of liver abscesses was a critical prerequisite for effective antimicrobial therapy.
- Chloramphenicol administration post-drainage resulted in dramatic clinical improvement and abscess resolution.
- Long-term chemoprophylaxis with trimethoprim/sulfamethoxazole for two years maintained clinical remission.
Implications:
- This case highlights the importance of considering surgical intervention in refractory liver abscesses associated with CGD.
- It underscores the potential efficacy of chloramphenicol in severe, treatment-resistant CGD-related infections.
- Effective long-term management strategies, including chemoprophylaxis, are crucial for improving outcomes in pediatric CGD.