Synchronous gastric cancer and adenomatous colorectal polyp in patients with Klebsiella pneumoniae-induced pyogenic liver abscess (KP-PLA) and bacteremia is a rare presentation. A 58-year-old man with a 6-month history of diabetes mellitus (DM) presented with febrile sensation and dull abdominal pain in the right upper quadrant of the abdomen. Subsequent to laboratory test results and abdominal computed tomography findings, KP-PLA with bacteremia was diagnosed. After intravenous antibiotic administration, his symptoms improved, and upper endoscopy and colonoscopy were performed to evaluate the cause of KP-PLA. Biopsy specimens of the prepyloric anterior wall revealed a moderately differentiated adenocarcinoma. Endoscopic mucosal resection of the colon revealed high-grade dysplasia. Early gastric cancer (EGC) and adenomatous colorectal polyps with high-grade dysplasia concomitant with KP-PLA and bacteremia were diagnosed in our patient who had DM. Intravenous antibiotic treatment for KP-PLA, subtotal gastrectomy for EGC, and colonoscopic mucosal resection for the colon polyp were performed. After 25 days of hospitalization, subtotal gastrectomy with adjacent lymph node dissection was performed. Follow-up ultrasound imaging showed resolution of the abscess 5 weeks post-antibiotic treatment, as well as no tumor metastasis. Upper gastrointestinal endoscopy and colonoscopy should be performed to evaluate gastric cancer in patients with PLA or bacteremia, accompanied with DM or an immunocompromised condition.
Pyogenic liver abscess with metastatic septic complications is a rare and serious infectious disease if not treated properly. Pyogenic liver abscesses are caused by bacterial, fungal, or parasitic organisms. Escherichia coli used to be the predominant causative agent, but Klebsiella pneumoniae emerged as a major cause in the 1990s. Liver abscesses are caused by hepatic invasion via many routes, such as, the biliary tree, portal vein, hepatic artery, direct extension, or penetrating trauma. Furthermore, diabetes mellitus and malignant conditions are established important risk factors of K. pneumoniae liver abscesses and of septic metastasis, and several recent studies have asserted that K. pneumoniae liver abscess might be a presentation of occult or silent colon cancer. We report a case of K. pneumoniae liver abscess, metastatic septic pulmonary embolism, and endophthalmitis associated with diabetes and advanced gastric cancer.
Citations
Citations to this article as recorded by
Gastric cancer and adenomatous colorectal polyp concomitant with pyogenic liver abscess and bacteremia Min Kyu Kang, Hee Jung Kwon, Min Cheol Kim Yeungnam University Journal of Medicine.2020; 37(3): 246. CrossRef
A Case of Advanced Gastric Cancer Concomitant with Pyogenic Liver Abscess in the Patient with Subtotal Gastrectomy Dong-Hee Park, Nae-Yun Heo, Heon Sa-Kong, Na-Ri Jeong, Su-Jin Jeong, Sung Jin Oh, Kyung Han Nam The Korean Journal of Gastroenterology.2017; 69(2): 143. CrossRef
Pyogenic granuloma is one of the common benign vascular tumors of infants and children and it can also occur in adults. There are 25 reports of patients with pyogenic granuloma in the Korean medical literature. In three reports, giant pyogenic granuloma developed over 2 cm in size (1.3 x 0.7 cm, 1.2 x 0.8 cm and 1.1 x 0.7 cm, respectively). There have been no reports in the Korean medical literature of pyogenic granuloma over 2 cm in size. Herein, we report on a giant pyogenic granuloma on the palm of a 72-year old female. The lesion was of an unusually large size of 2.8 x 2.5 x 1.3 cm and we excised it by performing electrosurgery.
Pyogenic vertebral osteomyelitis is rare. It most commonly occurs at the lumbar area and in the fifth to seventh decades of life. Most individuals present with back pain, abdominal pain, hip pain and meningeal syndrome. We experienced three cases of unusual patterns of pyogenic osteomyelitis. The first case developed after sepsis. The second case developed after open fracture and infection of other site. The third case was misdiagnosed as metastatic cancer. We present these cases with a brief review of literatures.