Upload
mona-mustafa
View
61
Download
5
Embed Size (px)
Citation preview
Case 167
By:Abdelwahab Elsadany
MD Pediatrics PhD ped study children special
need
دكتورعبد الوهاب محمد
السعدني الزقازيق طب ـ أطفال طب دكتوراه
الخاصة االحتياجات ذوى وتغذيه دكتوراه صحة
األطفال شمس عين طب ـ الحميات أمراض وعالج تشخيص في الدكتوراه
Name ……: Age; 65 yearsSex: femaleResidence: meat AliOccupation :house wifeMariatal state married
Social state HighDiabetic 20 years ago hypertensive 15 years ag
Personal history
Complaint
Fever for 3 months not responding to treatment
Headache , anorexia …easily tired sweating and occ
palpitationSense of abdominal discomfort and
fullness.………………
Present historyStarted 3 months ago by sudden onset of febrile illness with generalized boneache , headache, sweeting easily tired sense of abdominal fulness indigestion and anorexia
Fever increased at night with shivering sweating and shortness of breath with palpitation
diagnosed as Enterica
Patien asked many Med advices and all shared diagnosis of Typhoid fever
Treated 10 days with Ciprofloxacin twice daily with minimal improvement
Of some Symptoms
Patint reevaluated
Pyogenic sinsuits by ENT consultant based on xRay nasal sinuses
Received home medication Augmentin Two weeks
Minimal improvement of fever and headache
Patient by lab and positive lab for Malta fever Given treatment for brucellosis for 8 weeks with no response Asked medical advice by fever specialist
Refered to hospital with the above symptoms
No response
Through history and repeated physical examination revealed
General examinationAlert,conscious,active ,non toxicT 39 c
RR 22/mِHR 92/m
,B P 145/95Chest: BEAE
CVS: S1-S2-OGIT: soft no visceromegaly
CNS: NADL L minimal pertibial edema
LAB Results
CBC: TLC:9.6 RBCs: 3.64 HB: 10 PLAT: 296 ESR: 110 ASO: -VE CPR: 12 FU SUGAR :404
URINE ANALYSIS PUS: 5-7
GLUCOSE++ PROTEIN++ :
Widal 1l160 H:-ve
Brucella:-ve S.creatinine: 1
Liver enzymes: normalzٌKideny Function Normal
RADIOLOGICAL STUDY
CXRABD U S
ABDOMINIAL COPUTARIZED CTABD MRI
Chest x ray : freeAbdominal U/SMultiple focal lesions for C/T liver
CT ABDOMEN:Mildly enlarged liver with multiple variable sized marginally enhanced cystic lesions are seen scattered in both liver lobes and caudate lobe . the largest measures about 3.5 cm in diameter and located in medial segment of the left liver lobe…… signs cobe with multiple liver granulomas Normal enhancement of the main portal vein and its two main branches. No dilated intra-hepatic biliary rdicals
19-3-2012Refered for guided CT liver
aspiration and drainage for Histopathology and
microbiological study
BIOPSY under guide CT
Slowly growing gram +ve bacteria
:actinomyces israeli
LIVER BIOPSY
Monday 23-4-2012Resolution of all hepatic absceses
and largest one resoled with half cm in diameter
Pateient will continue ttt at hospital for further two weeks
under tttt by.…………………………………………………
Abstract
Femal ward 65ys diabetic hypertensive hepatic actinomycosis Acombination of surgrgical radiological dranage and antibiotic proved to lead to complet cure
للجميع شكرا
discussionActinomycosis liver abscess is comonly assoc with
nonspecific clinical and lab signs of infection
Immagine usualy review aspace occuping lesion suggest either hepatic
tumor or pseeudotumor or inflamatory Adefinitive diagnosis is histopathology tests on
sample obtained under screen
Adefinitive diagnosis is histopathology tests on sample obtained under screen
Felekouras et al (92) report hepatic lobectomy in ؛
Felekouras et al (92) report hepatic lobectomy in ؛
case of isolated hepatic actinomycosis(case report)
Ped R health sci J 11:19-21؛
Samuel 1999 Post g Med j liver acinomycosis as C/o diverticulosis
liver acinomycosis as liver mass by Vargas 92 medicine 21 111-115
0ٍsugano etal in Japan hapatic actinomycosis in japan case report J gastroentro 9732;;672;6
Ali et al 97 hepatic inv in diss actinomycosis Panc sur 3 ;337;9
Bown etal 2011 report acase presenting solely as hapatic mass co actinomycosis
{
Actinomycosis
ActinomycesSlow growing gram +ve bacteria , it is a part of the oral flora in humans, flamentous structure gives them fungal like appearance
discussioncase of isolated hepatic actinomycosis(case report)
Ped R health sci J 11:19-21؛
Samuel 1999 Post g Med j liver acinomycosis as C/o diverticulosis
liver acinomycosis as liver mass by Vargas 92
medicine 21 111-115
Actinomycosis
IActinomycosis is infection is infection caused by actinomyces bacteriaCharacterized by characteristic granulomatous suppurative disease characterized by peripheral spread with formation of draining sinus affect cervicofacial,thoracic,abdominal,pelvic
Actinomyces in clinical specimen sputum .crust purulent exudate surgical nacropsy ,rinsed stain reveal organisms with classic silver granules
c/sbrain,heart infection agar 37 c 95% nitrogen 5 % co2 incubate aenerobically organism within 24h israile filaments spiderlike growth
epidemiology worldwide without relation to age ,sex,race,season or occupation review 85% case youngest one 28day etiology human flora increased in patient with steroid leukemia renal cong imm def.HIV
pathogenesischronic suppurartive scaring inflammatory process with dense cellular infiltrate with suppuration forming many connecting abscess with sinus tractssite involves,lung.abdomen,orofacial
c/p of abdominal and pelvicafter disruption of mucosa of GIT hepatic affection 15% as solitary or multiple liver abscesseschillsfevernight sweetsweight losssimilar to TB
diagnosismicroscopic examination with appropriate stainc/s of purulent discharge actinomyces irregular non spore forming non acid fast non moblle gram +ve bacillusc/s aerobic non aerobic
abdominal CTa contrast enhancing multicystic lesions that can be approached by CT guided needle biopsy and C/S
Treatmentprolonged antibiotic therapy and drainaagePenicillin 250mg/kg/24h q4hTetracycilin clendimycin chloramephenicol injection 2-6 weeksOral3-12 months
THANK YOUBy:Abdelwahab Elsadany