Chronic Liver Abscess: Unresolved Symptoms and Treatment Challenges

Q: Chronic Liver Abscess: Unresolved Symptoms and Treatment Challenges

Mr. <br>Peter： Due to the complexity of the condition, I cannot provide specific recommendations. <br>Fever of unknown origin is a challenging issue in medicine. <br>Please cooperate with your physician to carefully monitor changes in your condition and adhere to the prescribed m

Liver abscess that does not heal over a long period?

Hello: My father is 72 years old.
In mid-April, he began experiencing abdominal pain and sought treatment at an internal medicine clinic.
An ultrasound indicated bowel gas, and after medication, the abdominal pain persisted.
In early May, he started having chills and fever at night, and the abdominal pain became more pronounced.
He visited the emergency room several times, where blood and urine tests showed elevated white blood cell counts, but other results were normal.
In mid-May, a CT scan revealed abnormalities in the liver, leading to hospitalization for observation.
He underwent colonoscopy, gastroscopy, and blood cultures, all of which returned normal results.
He was transferred to another hospital for a liver biopsy, which diagnosed a liver abscess; however, subsequent bacterial cultures did not identify any specific pathogens.
At the beginning of June, the doctor prescribed oral antibiotics for him to take at home.
After returning home, he continued to experience nightly chills and fever.
By mid-June, he also began to have fevers in the evening, and blisters appeared on his hands along with skin rashes.
He was admitted to the emergency room again, and the infectious disease department treated him with intravenous antibiotics.
Initially, he continued to have fevers at night and developed leg edema.
The blisters on his hands were biopsied for bacterial culture, but no abnormalities were found.
After about a week of treatment, the fever decreased, and the skin rashes and leg edema subsided.
However, he has recently started experiencing fevers again at night and in the evening.
I would like to know if there could be other factors causing this.

P.S.: My father has been taking antidepressants and Parkinson's medication for many years, has high blood pressure, no gout, no diabetes, has never had surgery, and has not had tuberculosis.
He wears dentures, and in early June, a dental examination revealed gum wounds due to remaining teeth causing occlusion, for which a gel was prescribed.
Since I am unsure which specialty to consult, I have temporarily filled out the form for the metabolism department.

Peter, 40~49 year old female. Ask Date: 2011/07/05

Dr. Chen Shidian reply Gastroenterology and Hepatology

Mr.
Peter: Due to the complexity of the condition, I cannot provide specific recommendations.
Fever of unknown origin is a challenging issue in medicine.
Please cooperate with your physician to carefully monitor changes in your condition and adhere to the prescribed medication.
Dr.
Chen Shidian from Changhua Hospital cares about your health.

Reply Date: 2011/07/05

More Info

Chronic liver abscesses can present significant diagnostic and therapeutic challenges, especially in elderly patients with multiple comorbidities. In your father's case, the persistent symptoms of fever, abdominal pain, and skin manifestations, despite antibiotic treatment, suggest a complex underlying issue that may not solely be attributed to the liver abscess.

Firstly, it is essential to understand that liver abscesses can be caused by various pathogens, including bacteria, fungi, and parasites. In cases where routine cultures fail to identify a specific organism, it may indicate a more atypical or resistant pathogen, or even a non-infectious etiology. Given your father's history of chronic illness and medication use, it is crucial to consider the possibility of drug interactions or side effects that could contribute to his symptoms.

The recurrent fevers and skin changes, such as the development of blisters and erythema, could suggest an underlying systemic infection or an inflammatory response. Conditions like drug-induced hypersensitivity or autoimmune reactions should also be considered, especially since your father is on multiple medications for depression and Parkinson's disease. These medications can sometimes lead to skin reactions or exacerbate underlying conditions.

In terms of management, it is vital to ensure that your father is under the care of a multidisciplinary team, including infectious disease specialists, hepatologists, and possibly dermatologists. They can work together to reassess his treatment plan and consider alternative diagnoses. For instance, if the abscess is not responding to antibiotics, imaging studies such as ultrasound or CT scans may be necessary to evaluate for complications like abscess rupture or the presence of additional abscesses.

Furthermore, if there is a suspicion of an autoimmune process or a drug reaction, a referral to a rheumatologist may be warranted. They can perform specific tests to rule out conditions like vasculitis or other systemic inflammatory diseases that could explain the fever and skin symptoms.

In addition to medical management, supportive care is crucial. This includes ensuring adequate hydration, nutritional support, and pain management. If your father is experiencing significant discomfort or has difficulty eating due to abdominal pain, a consultation with a nutritionist may be beneficial.

Lastly, it is essential to maintain open communication with the healthcare team. Keeping a detailed log of symptoms, medication changes, and any new developments can help the doctors make informed decisions about your father's care. If the current treatment plan does not yield improvement, do not hesitate to seek a second opinion or ask for further diagnostic testing to explore other potential causes of his symptoms.

In summary, the management of chronic liver abscesses and their complications requires a comprehensive approach that considers all possible underlying factors. Close monitoring, collaboration among specialists, and a willingness to adapt the treatment plan based on your father's evolving clinical picture will be key to addressing his ongoing health challenges.

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