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Cryptogenic hepatic abscess in two uncompromised children
Insights
Cryptogenic liver abscesses in children are rare but should be considered for unexplained fevers. Prompt diagnosis and drainage are key for recovery, even without an identified cause.
Area of Science:
- Pediatric Infectious Diseases
- Hepatology
- Microbiology
Background:
- Cryptogenic liver abscesses are uncommon in pediatric patients.
- Pyrexia of unknown origin (PUO) necessitates a broad differential diagnosis in children.
- Early consideration of hepatic abscess is crucial for timely intervention.
Observation:
- Two previously healthy children presented with suspected liver abscesses.
- Diagnostic imaging (radioisotopic, sonographic, angiographic) supported the clinical suspicion.
- Surgical drainage was performed, revealing pure cultures of anaerobic bacteria (microaerophilic streptococcus and Fusobacterium necrophorum).
Findings:
- The exact source and cause of the liver abscesses remained undetermined in both cases.
- Isolation of specific anaerobic bacteria highlights their potential role in pediatric liver abscesses.
- Successful treatment involved prompt diagnosis, surgical drainage, and appropriate antibiotic therapy.
Implications:
- This case series underscores the importance of considering cryptogenic liver abscesses in children with PUO.
- Hepatic abscesses can occur in otherwise healthy children, with or without mild gastrointestinal symptoms or underlying conditions like sickle cell disease.
- Effective management relies on high clinical suspicion, thorough investigation, surgical intervention, and targeted antimicrobial treatment.
Abstract:
A pre-mortem diagnosis of cryptogenic liver abscess in children is rare, but this diagnosis must be considered in the evaluation for pyrexia of unknown origin. Two previously healthy children were suspected of harboring liver abscesses. Radioisotopic, sonographic, and angiographic evidence supported the clinical diagnosis. Operative drainage was performed in each case. No source for either abscess was found and no cause established. Anaerobic bacteria, microaerophilic streptococcus and Fusobacterium necrophorum, each in pure culture, were retrieved on culture of the pus from each child's abscess. Experience gleaned from these two cases emphasizes the possibility of an hepatic abscess existing in the uncompromised child with fever of unknown origin. A cryptogenic hepatic abscess may occur in a child with only mild gastrointestinal complaints and in a child with sickle cell disease. Recovery is attributed to suspicion of diagnosis, prompt investigation, operative drainage, effective culture technique with isolation of organism and appropriate antibiotic coverage.