We report the case of 61-year-old woman with cryptogenic
liver abscesses who had been profoundly ill with severe upper
abdominal pain, impaired consciousness, prostration, continuous high
fever secondary to
sepsis, and
thrombocytopenia (platelets, 1-5 x 10(4)/mm3) since admission. Ultrasonograms and computed tomograms revealed two separate multiloculated lesions in the right lobe of the liver, consistent with the
liver abscesses. Immediately after diagnosis, percutaneous
abscess drainage was performed under ultrasonographic guidance; however, only a small amount of
pus was drained, prompting continuous irrigation of the
abscess cavity. Four days later, transcatheter hepatic arterial infusion of
antibiotics was attempted. However, the
abscesses had enlarged and her general condition had worsened. On hospital day 8, she underwent right
hepatectomy because the multiloculated lesions were refractory to drainage. The operation was successful in terms of
hepatectomy, although she continued to suffer from
sepsis, secondary right
subphrenic abscess formation, and prolonged
thrombocytopenia with associated coagulation disorders for two months. Examination of multiple cross sections of the resected specimen disclosed that the lesions consisted of aggregations of multiple small locules. There was no communication between the locules and there were true septations, rather than multiloculated lesions with pseudoseptations. The patient has been well for 2 years without recurrent
abscess of the liver or any
infectious disease.