Huge pyogenic liver abscess in a toddler: Resolution using antibiotics without drainage.

Abstract

Pyogenic liver abscess is an uncommon disease in children; it is associated with high mortality if treatment is delayed. Percutaneous drainage and systemic antibiotics are the preferred treatment of choice, while surgery is reserved for complicated cases. It is seldom treated with antibiotics alone. The case is A.I, a 3-year old girl that was admittedin our facility with ten days history of fever with progressive and painful right-sided abdominal swelling. She was febrile, and had huge tender hepatomegaly. Her  abdominal ultrasound and Computerized Tomography-scan findings were consistent with pyogenic liver abscess; and the result of her blood culture yielded staphylococcus aureus.She had low corrected serum calcium,  hypoalbuminemia and hypokalemia. She was placed on broad spectrum antibiotics and supportive treatment before parents decided to leave the hospital against medical advice. Review after completing two weeks of oral formulation of 'blood culture-guided antibiotics' showed remarkable resolution of the abscess and restoration of normal clinical state without the need for drainage. Pyogenic liver abscess is not a common disease in children but it could be life-threatening in affected individuals. A guided use of appropriate antibiotics is very important and may aid resolution where percutaneous drainage or surgery seems impossible.

Keywords: Pyogenic, Toddler, Hepatic, Abscess, Percutaneous drainage.