A liver abscess is defined as a pus-filled mass in the liver that can develop from an intra-abdominal infection disseminated from the portal vein or from injury to the liver. Liver abscesses can be broadly divided into two categories: amoebic and pyogenic. The clinical presentation of pyogenic liver abscess is nonspecific; thus, a high index of suspicion is required for timely diagnosis. The classic triad of right upper quadrant discomfort, fevers/chills, and malaise is only present in approximately 30% of patients. A 66-year-old patient reports to a family doctor for pain below the right costal arch that lasts for about eight days and occurs after strenuous physical work, and he is occasionally feverish to 38 degrees. No physical signs of ascites were found, liver, and spleen were unpalpable during the physical examination. He was examined by ultrasound of the abdomen and multiple focal liver lesions in both liver lobes were detected. He was referred to a gastroenterologist and CT showed multiple hypodense irregular formations intraparenchymal and sub-capsular in the liver. Micrococcus luteus and Enterococcus faecalis were detected in blood cultures. Ultrasound-guided drainage of the largest focal lesion was performed. Parenteral and i.v. antibiotic therapy is introduced into the therapy. In the further course, the patient was in good general condition, afebrile, laboratory parameters were in the reference interval and he was discharged for further home care. Without treatment, pyogenic liver abscess has a mortality rate of 100%. When treated, this value currently drops to about 2.5% and 14%. Recognition of the features of pyogenic abscess on imaging, laboratory findings and clinical picture allows early diagnosis and rapid introduction of appropriate therapy resulting in better prognosis and reduction of complications and risk of mortality.
3 March 2022 in Journal of Clinical and Experimental Investigations
Herpes simplex virus encephalitis (HSVE) is an acute or subacute illness associated with focal or global cerebral dysfunction. It is caused by herpes simplex viruses belonging to either type 1(HSV-1) or type 2(HSV-2). Most of HSVE is caused by HSV-1. The most common manifestations include encephalopathy, fever, seizures, headaches, and focal neurological deficits. 49-year-old patient who has diabetes mellitus type 1, first presented with a fever, followed by a generalized epileptic seizure. In the Emergency Room a lumbar puncture was performed, and HSV-1 was detected in the cerebrospinal fluid. MR of the brain concluded that the changes correspond to the changes within HSV-1 encephalitis with a smaller area of hemorrhage. The patient was prescribed with acyclovir 3×10 mg/kg i.v. for three weeks. After antiviral therapy and glycemic control, the patient was discharged with antiepileptic, antihypertensive, antiulcer and antidiabetic drugs and indication to do a control EEG and infectologist exam with laboratory findings. HSVE has high morbidity and mortality, and the treatment of choice is acyclovir therapy.