Lack of efficacy: case reportA 36-year-old woman exhibited lack of efficacy while receiving treatment with ceftriaxone for pyogenic liver abscess. The woman presented to the emergency department with intractable right hypochondrial and shoulder pain. Two weeks prior to the presentation, she developed right hypochondrium and epigastric pain, radiating to the right shoulder, dull aching, gradually worsening associated with nausea and vomiting. Her medical history was significant for asthma, hypertension and lactose intolerance. The laboratory findings showed that she was afebrile, had elevated BP and was mildly distressed due to severe abdominal pain. The abdominal examination revealed normoactive bowel sounds. The further laboratory examination revealed right hepatic lobe abscess. Therefore, pyogenic liver abscess was considered. She was then admitted to the hospital and started receiving an empirical treatment with cefepime and metronidazole. The CT-guided liver abscess drainage and pig-tail catheter placement resulted in drainage of 200cc of foul-smelling, thick and maroonbrown fluid. The fluid culture was also positive for Klebsiella pneumonia. Thereafter, she started receiving treatment with ceftriaxone [dosage and route not stated] for pyogenic liver abscess. Despite abscess drainage and appropriate ceftriaxone therapy, her condition continued to deteriorate as she developed signs of sepsis with worsening right sided chest pain and leucocytosis. Thus, lack of efficacy with ceftriaxone was considered. The further examination showed a newly formed right-sided large multi-loculated pleural effusion concerning for encysted empyema. Thereafter, she underwent video-assisted thoracoscopic surgery decortication and laparoscopic liver abscess drainage and marsupialisation. As a result, her condition improved and was discharged one week after the procedure with a scheduled ciprofloxacin treatment for 10 days.
