Cardiac tamponade due to perforation of aRoseomonas mucosapyogenic hepatic abscess as initial presentation of hepatoid carcinoma

Abstract

Hepatic abscesses can rarely cause pericardial disease by erosion into the pericardial space and present with haemodynamic instability due cardiac tamponade. While rare, these dramatic presentations are more often due to amoebic abscesses than bacterial abscesses. Importantly, a cause must be found for any cryptogenic hepatic abscess regardless of presentation, as there is a high association with underlying malignancy. We report a previously healthy man in his 30s who presented with cardiac tamponade from perforation of a Roseomonas mucosa pyogenic hepatic abscess into the pericardium in the absence of bacteremia and biliary disease. One year later, he was found to have diffusely metastatic hepatoid carcinoma.

GiantKlebsiella pneumoniaepyogenic liver abscess in the left liver lobe presenting with dyspepsia and vaginal discharge

“…Given the enormity of the abscess, symptoms related to anatomical compression should always be considered in giant lesions, for example, one case of a large hepatic cyst caused acute breathlessness and chest discomfort due to compression on the right ventricle 23. If our patient had not received early definitive treatment, the small pericardial effusion may have worsened to tamponade, which occurred in a 30-year-old man who was diagnosed with a PLA after 6 weeks of symptoms, requiring emergency pericardiocentesis 24…”

Cellulitis caused by Roseomonas mucosa in a child: a case report

“…Reports of R. mucosa infection in humans are limited; however, there have been reports of catheter-related bloodstream infections [ 5 – 14 ] and infections in immunocompromised patients. Cases of bacteremia [ 4 – 18 ], peritonitis [ 18 – 21 ], meningitis [ 22 ], infection of soft tissues [ 4 ], spinal epidural abscess [ 23 ], pyogenic spondylitis [ 16 ], cholangitis [ 11 ], subretinal abscess [ 24 ], infection of the root canal [ 25 ], and liver abscess [ 26 ] have also been reported. R. mucosa is resistant to broad-spectrum cephalosporins [ 2 , 3 ].…”

“…Many patients in these reports were immunocompromised [ 5 – 15 , 17 – 21 , 24 ] or had catheter-related [ 5 – 14 ] or postoperative infections [ 16 , 22 , 23 ], with few reports of infection in patients without these characteristics [ 26 ]. Reports of skin and soft tissue infections are also rare.…”