Liver Abscess due to Atpical Mycobacterial Disease Diagnosed by Laparoscopic Partial Liver Resection in a Patient with Acute Myelocytic Leukemia

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  • MATSUURA Masato
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University Department of Gastroenterological Surgery, Nishi-Kobe Medical Center
  • HATANO Etsuro
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University
  • ISHII Takamichi
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University Department of Gastroenterological Surgery, Nishi-Kobe Medical Center
  • FUJIMOTO Yasuhiro
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University
  • MIZUMOTO Masaki
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University
  • UEMOTO Shinji
    Division of Hepatobiliary Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University

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Other Title
  • 腹腔鏡下肝部分切除術で診断した非結核性抗酸菌症による肝膿瘍の1例
  • 症例 腹腔鏡下肝部分切除術で診断した非結核性抗酸菌症による肝膿瘍の1例
  • ショウレイ フククウキョウ カ カン ブブン セツジョジュツ デ シンダン シタ ヒケッカクセイ コウサンキンショウ ニ ヨル カン ノウヨウ ノ 1レイ

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Abstract

A 49-year-old woman developed high fever and increases in white blood cell count and C-reactive protein (CRP) with after chemotherapy for acute myelocytic leukemia. She was diagnosed with multiple liver abscesses by PET/CT. Ultrasound-guided percutaneous fine-needle biopsy of the hepatic lesion was performed, but no causative microorganism was identified. The clinical course supported the diagnosis of fungal liver abscess, and antifungal medical treatment was started. However, CRP remained positive, and PET/CT revealed progression of the liver abscess. Laparoscopic partial resection of three lesions was performed for identification of causative microorganism and susceptibility testing.<BR>Histopathological findings indicated epithelioid cell granuloma with caseation necrosis, and Ziehl-Neelsen staining detected mycobacterium. Although the QuantiFERON®-TB Gold In-Tube test was negative, the causative microorganism could not be identified from laboratory culture ; therefore, the patient received four-agent combination therapy for atypical mycobacterial disease. She received allo-peripheral blood stem cell transplantation 4 months after the operation, and her condition has been stable.<BR>Identification of causative microorganisms by ultrasound-guided percutaneous fine-needle liver biopsy is difficult and may not provide a definitive diagnosis. Alternatively, laparoscopic partial liver resection can be useful in making an etiological diagnosis and treatment.

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