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Related Concept Videos

Pneumonia I: Introduction01:30

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Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
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Pneumococcal perihepatitis due to hematogeneous dissemination.

Koichiro Okumura1, Yu Sato1, Hiroaki Yonekura1

  • 1Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan.

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Perihepatitis, often linked to pelvic inflammatory disease, can also stem from Streptococcus pneumoniae. This case highlights the importance of blood cultures for identifying the infection source in atypical perihepatitis presentations.

Keywords:
BacteremiaInvasive pneumococcal diseasePerihepatitisStreptococcus pneumoniae

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Area of Science:

  • Infectious Diseases
  • Hepatology
  • Microbiology

Background:

  • Perihepatitis is commonly associated with pelvic inflammatory disease (PID), typically caused by Neisseria gonorrhoeae or Chlamydia trachomatis.
  • PID-related perihepatitis is usually seen in sexually active individuals with relevant symptoms or findings.

Observation:

  • A 61-year-old female presented with fever and right upper quadrant pain, diagnosed with perihepatitis via contrast-enhanced computed tomography.
  • The patient had no history of sexual activity or symptoms suggestive of PID.
  • Blood cultures identified Streptococcus pneumoniae, suggesting a hematogenous dissemination route.

Findings:

  • The case demonstrates that Streptococcus pneumoniae, a common cause of invasive pneumococcal disease, can lead to perihepatitis.
  • This challenges the typical understanding of perihepatitis etiology, which is predominantly sexually transmitted infections.

Implications:

  • Blood cultures are crucial for determining the causative pathogen and infection route in perihepatitis, especially in patients without risk factors for PID.
  • This finding broadens the differential diagnosis for perihepatitis, emphasizing the need to consider non-gynecological sources like pneumococcal bacteremia.