Hellenic Journal of Surgery 89 Pyogenic Liver Abscess of a Male Patient with Diabetes Mellitus due to Escherichia coli with Fever and Chills as the Only Symptoms Georgios Zacharis, Nada Zacharis, Charalampos Potsios, Panagiota Xaplanteri Hellenic Journal of Surgery (2017) 89:1, 40-42 Georgios Zacharis, Department of General Surgery, St. Andrew’s General Hospital, Patras, Greece Nada Zacharis, GP, Internal Medicine, Patras, Greece Charalampos Potsios, Kalavryta General Hospital, Kalavryta, Greece Panagiota Xaplanteri 4 Technological Educational Institute of Western Greece, Nursery School, Patras, Greece Corresponding author: George Zacharis, Department of General Surgery, St. Andrew’s General Hospital, Patras, Greece Tel.: 0030-2610-322362 Fax: 0030-2610-322362 E-mail: georgioszacharis@gmail.com Received 16 Oct 2016; Accepted 15 Nov 2016 CASE REPORT Abstract Pyogenic liver abscesses (PLAs) are the most frequent visceral abscesses with predominance in men. They are extremely rare and their mechanism of formation is extended to infection of an anatomically contiguous organ or hematogenous seeding. Diabetes mellitus is a major predisposing factor and if so, the mortality rate is high. The most common clinical presentation forms are fever with chills, abdominal pain and hepatomegaly. In the present report we present the case of a 65-year-old Greek male patient with history significant for diabetes mellitus, who attended the emergency department complaining of fever and chills for five days. The final diagnosis was pyogenic liver abscess of the right lobe. Blood cultures were positive for Escherichia coli. The patient was treated with broad spectrum antibiotics and percutaneous drainage of the abscess. To our knowledge, this is the first pyogenic liver abscess in a diabetic patient due to E. coli reported in Western Greece. Key words: Pyogenic liver abscess; diabetes mellitus; Escherichia coli; percutaneous drainage Case report A 65-year-old Greek male patient with medical history significant for diabetes mellitus, attended the Emergency Department of the Hospital of his home town due to fever up to 40 ο C with chills for five days. Physical examination revealed normal breath sounds, there were no clinical signs of meningeal or abdominal infection (Murphy and Giordano signs were absent). Abdominal ultrasonography was unre- vealing. During admission, urine cultures were negative, whereas blood cultures were positive for Escherichia coli. The patient was treated with ciprofloxacin and meropemen intravenously, according to the susceptibility test, but his fever did not retreat. After three days of antimicrobial ad- ministration, the abdominal ultrasound was repeated, but it was again unrevealing. Therefore, the patient underwent computerised tomography of the abdomen and retrop- eritoneal space, which revealed a multi-lobulated feature sized 15.9×10.4 cm in the right hepatic lobe, consistent with liver abscess. Moreover, there was air in the biliary tree, which was a sign of infection (Figure 1). In the light of these findings, the patient was transferred to a tertiary Hospital for treatment. Upon admission in the tertiary hospital, laboratory findings showed white blood cell count 13,200 cells/mm 3 , with 88% neutrophils, anemia [hematocrit 33.2%, (normal values 40.5-47%)], low serum sodium levels 133 mmol/L (normal values 136-145 mmol/L), and elevated levels of serum glucose 212 mg/dL (normal values 74-106 mg/dL), Introduction Liver abscesses are categorised into two major types: amebic and pyogenic. Amebic liver abscess is a specific hepatic disease due to invasive Entamoeba histolytica in- fection. On the other hand, the pathogenicity of pyogenic liver abscesses (PLAs) varies and depends on the way of entry of the culpable microbe. The most common inva- sion sites are the biliary tree, the portal vein, the hepatic artery, and penetrating trauma and the spread can be either hematogenous or by extended infection of an anatomically contiguous organ [1].