投稿分類 微生物

主委發表種類: 壁報

投稿標題(中): 齧蝕艾肯氏菌引起的巨大肝膿瘍

投稿標題(英): Huge hepatic abscess caused by Eikenella corrodens: A rare case report

投稿摘要: Introduction: (前言)
Eikenella corrodens is one of the HACEK group (Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella) organisms, which is normal flora of the human oral cavity, upper airway, and mucosal surfaces of the gastrointestinal and genitourinary tracts.[1] It has only been sporadically described in patients with risk factors and presented with endocarditis, pericarditis, head and neck infection, intra-deltoid abscess, brain abscess, perirenal abscess, liver abscess, and hip arthritis.[2]

Case presentation: (方法)
We found a 59-year-old female, who is a temple master with history of intra-hepatic bile duct carcinoma s/p mental stent implant on 2022/09/08. She complained of intermittent high fever with chills and epigastric pain for one week. It’s associated with nausea with poor appetite. On admission, her physical examination showed right abdominal dullness pain and distention. Laboratory data displayed leukopenia with bandemia (WBC 2040/uL, N.band 46.6%), high C-reactive protein (24.22mg/dL), and elevated total bilirubin(1.31mg/dL) with normal AST/ ALT. At first, antibiotic treatment as Flomoxef was prescribed for suspected intra-abdomen infection. The abdomen CT on 2023/02/23 showed fluid accumulation over perihepatic region with thickening of hepatic capsule about 19x5 cm, suspicious of abscess formation(Fig. 1). Radiologist was consulted for drainage of right peritoneal abscess on 02/24. Fever subsided and her appetite improved in further hospital days. The cytology reported Negative for malignant cells. Neither clinical specific signs of endocarditis nor valvular murmurs at the clinical examination were noticed. The echocardiography was arranged with result of no vegetation.

(結果)
The pus culture on 02/24 and 03/06 reported Eikenella corrodens, we changed antibiotic to ampicillin/ sulbactam according to review of literatures and the antibiotic susceptibility testing(Fig. 2) on 03/13. The followed pus culture on 03/20 grew Staphylococcus caprae only. Her blood culture on 02/17, 03/10, 03/13 and 03/20 revealed no growth consequently. Days later, the percutaneous abscess drainage showed very little amount and abdominal echography revealed minimal amount ascites, we removed the drainage tube on 03/20. With stable condition, she discharged with oral antibiotic on 03/22.

Discussion: (討論)
A systematic review of the medical literature in PubMed® was performed. Eikenella corrodens is a part of the normal flora of human oropharynx, but it can migrate to other parts of the human body to cause severe invasive disease in humans. It is a relatively rare microorganism in human infectious diseases, and head and neck infection is the most common type. Few cases of Eikenella corrodens causing hepatic abscesses, which may result from haematogenous seeding from the systemic circulation, gallstones or malignancies and risk factors include hepatobiliary infection, pancreatic disease, diabetes and prior liver transplant have only been reported previously. [3] However, all blood cultures of our patient showed negative result, and echocardiography reported no specific result, such as vegetation.
E. corrodens is generally susceptible to amoxicillin-clavulanate, ampicillin-sulbactam, most 2nd and 3rd generation cephalosporins, and carbapenems. It is resistant to clindamycin, macrolides, metronidazole, and aminoglycosides. [4] Our drug susceptibility test with disk diffusion method reported P(23mm), Amc(26mm), SAM(24mm), LVX(＞24mm), CIP(＞24mm), MEM (＞24mm), CTX (＞24mm), CRO (＞24mm), TE (30mm), SXT (30mm). According to review of literatures and the above result, we prescribed penicillin-based antibiotics instead of fluoroquinolones and cephalosporin-based antibiotics. Despite of limited pathogenicity, Eikenella corrodens should be considered as a potential pathogen causing hepatic abscess and multiloculated abscess may require timely and sufficient surgical drainage. [5] In our patient, drainage tube was placed for 25 days, followed by 10-day antibiotic course.

Conclusion: (結論)
We described a 59-year-old female with history of intra-hepatic bile duct carcinoma s/p mental stent implant on 2022/09/08 was diagnosed as having rare huge hepatic abscess. Although Eikenella corrodens is not common microorganism in hepatic abscess, but it should be noticed in the patient with risk factors of immunocompromise and hepatobiliary malignancy. Treatment for Eikenella corrodens hepatic abscess should be appropriate antibiotics plus adequate drainage.

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