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Symptoms and Management of Aseptic Liver Abscesses
Susanne Hafner1, Thomas Seufferlein2, Alexander Kleger2
1Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, University Ulm Medical Centre, Ulm, Germany.
Abstract:
Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.
Insights
Aseptic liver abscesses are rare and difficult to diagnose, often occurring with inflammatory bowel disease. Immunomodulatory therapy is crucial for managing these sterile abscesses and preventing relapses.
Area of Science:
- Hepatology
- Immunology
- Gastroenterology
Background:
- Aseptic liver abscesses are rare, posing diagnostic challenges due to lack of clinical guidelines.
- Sterile hepatic abscesses are infrequently encountered and often misdiagnosed.
Purpose of the Study:
- To analyze case reports of aseptic liver abscesses to understand their characteristics, diagnosis, and management.
- To identify associations between aseptic liver abscesses and other conditions, and evaluate treatment outcomes.
Main Methods:
- Systematic screening of MEDLINE and PUBMED databases for case reports from inception to November 2022.
- Analysis of patient demographics, symptoms, comorbidities, treatments, and disease course.
Main Results:
- Thirty cases of aseptic hepatic abscesses were identified, frequently involving the spleen (n=18).
- Common presentation includes fever, abdominal pain, and elevated inflammatory markers, with frequent comorbidity with inflammatory bowel disease (n=18).
- High recurrence rates (10/14) observed in long-term follow-up, suggesting a need for maintenance therapy.
Conclusions:
- Aseptic liver abscesses should be suspected in cases of sterile abscesses unresponsive to antibiotics.
- Immunomodulatory maintenance therapy is warranted due to the high risk of recurrence in patients with aseptic liver abscesses.
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