3197 Pyogenic Liver Abscess in B-Thalassemia: A Case Report

Abstract

INTRODUCTION: Pyogenic liver abscess typically develops via systemic seeding of an infection or from biliary disease through direct spread or portal circulation. Invasive liver abscess though may occur in Beta-thalassemia major patients are a rarity in Beta-thalassemia minor. CASE DESCRIPTION/METHODS: 36-year-old woman with a history of B-thalassemia minor presents to the ED with complaints of acute onset severe, non-radiating right upper quadrant pain. She endorses fevers, chills and night sweats but denied anorexia, nausea, vomiting, diarrhea or urinary symptoms. Never been transfused. Physical exam was pertinent for a temperature of 102.8 F, tachycardia of 138 bpm, and an upper quadrant abdominal tenderness with some guarding. Labs was notable for leukocytosis with neutrophil predominant, anemia with Hb of 5.3 g/dl. Elevated ESR and CRP. Lipase and amylase were normal. CT abdomen showed 10.3 cm thick-walled, complex fluid collection in the right hepatic lobe and splenic abscesses consistent with a pyogenic abscess. Blood cultures were negative. She was started on empiric antibiotic with vancomycin and piperacillin/ tazobactam and was subsequently taken to interventional radiology for drainage of the abscess, with a J-P drain left insitu. The patient received 2 units of packed red blood cells. Fluid culture from drain was positive for Klebsiella pneumoniae which was sensitive to Levaquin. The patient's condition improved while on antibiotics with subsequent removal of the J-P drain. She was successfully discharged on oral Flagyl and Levaquin for 14 days. DISCUSSION: Typically, thalassemia minor carriers are clinically asymptomatic with very little to no complications. Infections however, are a major complication, and constitute the second most common cause of mortality and a main cause of morbidity in patients with thalassemia. The major culprit bacterial infections in thalassemia patients are Klebsiella sppand Yersinia enterocolitica. K. pneumoniae is also associated with a community-acquired primary invasive liver abscess syndrome. Liver abscess occur more commonly in beta- thalassemia major as these group of patient have predisposing factors such as underlying hepatobiliary dysfunction and recurrent transfusions. This condition is rare in beta- thalassemia minor. Abscess rupture is a rare complication, while metastatic infection to other sites can occur. Diagnosis is usually made with CT scan of the abdomen while treatment is should be started with empiric broad-spectrum and drainage of the abscess.