Pyogenic liver abscess as the first manifestation of hepatobiliary malignancy

Pyogenic liver abscess (PLA) is commonly seen in patients in the Far East. Similarly, hepatobiliary neoplasms are also common. PLA as the initial manifestation of hepatobiliary neoplasms is extremely rare.

Three patients with PLA were identified from the ward registion files and were retrospectively reviewed.

These patients (two men aged 74 and 80 years, and one woman aged 35 years) were treated (in the right lobe in two patients and in the left lobe in one) and subsequently followed up for 11-22 months. Two patients were diagnosed with hepatocellular carcinoma and one with metastatic cholangiocarcinoma. Two patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular carcinoma. One patient underwent hepatic resection with good results. In the other two patients who declined any further interventions, one died a few weeks after diagnosis and the other is still alive on conservative treatment.

This series of cases highlights the importance of considering underlying hepatobiliary malignancies in patients with PLA and a close follow-up necessary for non-resolving hepatic lesions.