This is a 72-year-old male patient with a history of type 2 diabetes mellitus and hypercholesterolemia in pharmacological treatment, with no family history of interest or previous surgical interventions.
She was admitted by her primary care physician with a three-week history of general malaise, dysthermic sensation and deaf pain in the right hypochondrium.
The patient denied recent changes in intestinal transit, rectal bleeding or melonic stools.
Physical examination only revealed abdominal discreetly painful hypochondrium without visceromegaly.
Analytically it presents: leukocytes: 14.3 x 109/L total bilirubin alkaline); hemoglobin: 1 g/dL (CMV: 89.7 fL, HCM: 29.2 pg); LDH: 203 U/L
Serology for hepatotropic virus, Brucella and Equinococcus as well as serial hemocultives and determination of tumor markers were negative or in normal ranges.
Abdominal ultrasound identified a space occupying lesion in the right hepatic lobe (8.5 x 6.8 cm), polylobulated, with areas of cystic aspect inside.
Median abdominal-pelvic computed tomography (CT) with contrast confirmed this image, which presented hypodense peripheral enhancement zones, together suggesting hepatic abscess.
Puncture-aspiration with needle obtained abundant purulent material, whose analysis was consistent with acute nonspecific inflammation, with no evidence of malignancy.
Microbiological culture and aspirate cultures were negative.
After the administration of broad-spectrum antibiotics (ceftriaxone, metronidazole and gentamicin) and the implantation of percutaneous drainage a favorable clinical outcome was obtained, with practice remission of the lesion in a subsequent radiological control.
In order to investigate possible underlying pathogenic conditions, an exophytic lesion close to the ileocecal valve was identified following cecal adenocarcinoma of malignancy; the anatomopathological study confirmed the diagnosis of adenocarcinoma.
The extension study revealed no metastatic dissemination or other lesions at the hepatic level, except for right hemicolectomy with subsequent administration of adjuvant chemotherapy (capecitabine).
The patient remains disease-free after 14 months of follow-up.
