We report the case of a 78-year-old man with a history of hypertension, hyperuricemia, renal lithiasis and cholecystectomy performed four months earlier.
The patient came to the emergency department for fever, right lumbar pain and loss of 2 kg of weight in the last 3 months.
An abdominal ultrasound performed before admission showed enlarged spleen (15 cm) and bilateral renal cysts, liver, pancreas and bile duct showed no abnormalities.
Analytically, there was an increase in erythrocyte sedimentation rate, 86 mm/h, increase in C-reactive protein, 69.9 mg/l, increase in fibrinogen, 731 mg/dl and persistent fever 11 g/dl.
An abdominal CT was performed showing hypertrophy of the left lobes and hepatic tail suggestive of chronic liver disease, also showing a subheptic abscess of 1 cm and a thickened gastric colonic pyloroduodenum with enlarged liver wall.
Subsequently, an overlying lesion of 2 cm, depressed in its central region, in the hepatic angle of the colon, was performed.
Biopsies of this lesion showed necrosis and colonic mucosa without malignant cells.
The patient continued with fever, elevated acute phase reactants and anemia, reason why ultrasound-guided drainage of the subhepatic abscess was performed.
A 8.5 Fr pigtail catheter was inserted, evacuating 40 ml of purulent fluid and leaving the catheter after the procedure.
Citrobacter freundii, Streptococcus viridians and Baoides spp. sensitive to imipenem were isolated from the purulent fluid culture and added to the treatment.
Five days after drainage of the abscess was performed placement, since the previous biopsy had been negative for malignancy.
In the same location, in the hepatic angle of the colon, a flat lesion of 1 cm was observed, from which new samples were taken in which no cells were observed.
A follow-up abdominal ultrasound showed no evidence of subhepatic abscess and the catheter was removed.
