Gas-forming Pyogenic Liver Abscess in an Immuno Competent Young Adult Male

Back GroundPyogenic liver abscess is a relatively uncommon condition associated with significant morbidity and mortality. Gas-forming Pyogenic liver abscess is even less common, accounting for 7 %24 % of all pyogenic liver abscess, occur more frequently in adults with comorbid conditions like diabetes mellitus, cirrhosis, pancreatitis, inflammatory bowel disease, pyelonephritis, and peptic ulcer disease, Organism most commonly associated with both Pyogenic and Gas forming pyogenic liver abscess is Klebsiella. Case ReportA 34-year man, admitted with a 10 day history of fever (102-103F), vague epigastric pain since 1week, generalized weakness and loss of appetite for 1 week. He had a past history of one attack of acute cholecystitis two and a half month back when ultrasound scan of abdomen suggestive acute cholecystitis and liver abscess. He was treated conservatively and discharged after 5 days with advise to continue on oral antibiotics for 4 wks. Patient remained symptom free till he presented to us. InvestigationsShowed Neurtrophilic leukocytosis, deranged LFT, ultrasound abdomen suggestive of large gas forming liver abscess confirmed by CT abdomen, pus culture and blood culture grew klebsiella species. ConclusionsThis case highlights that Gas forming pyogenic liver abscess can also occur in patients who are non-diabetic and are often sicker and require urgent drainage of the abscess. It is very important to perform imaging studies early to reach a diagnosis, as it is still associated with a high mortality.