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Pyogenic Ventriculitis Secondary to Liver Abscess

Authors:
Mayuki Omatsu
Mayuki Omatsu
Mayuki Omatsu
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Kohei Yamakawa at Kobe University
Kohei Yamakawa
Jyunya Taki
Jyunya Taki
Jyunya Taki
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Shujiro Yazumi
Shujiro Yazumi
Shujiro Yazumi
  • This person is not on ResearchGate, or hasn't claimed this research yet.
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doi: 10.2169/internalmedicine.1758-18
Intern Med Advance Publication
http://internmed.jp
【PICTURES IN CLINICAL MEDICINE 】
Pyogenic Ventriculitis Secondary to Liver Abscess
Mayuki Omatsu 1, Kohei Yamakawa 1, Jyunya Taki 2and Shujiro Yazumi 1
Key words: Pyogenic ventriculitis, liver abscess, Streptococcus anginosus
(Intern Med Advance Publication)
(DOI: 10.2169/internalmedicine.1758-18)
A 59-year-old man with chronic periodontitis presented
with a high-grade fever. He had no medical history associ-
ated with immunosuppression. Laboratory studies showed
elevated liver enzymes and inflammatory markers. Ultra-
sonography and magnetic resonance imaging (MRI) demon-
strated liver abscess in the left hepatic lobe (Picture 1). The
day after antimicrobial therapy was initiated, an altered level
of consciousness appeared. Fluid-attenuated inversion recov-
ery MRI and diffusion-weighted imaging on MRI revealed
periventricular hyperintense signal and ventricular debris
(Picture 2). Pyogenic ventriculitis secondary to liver abscess
was diagnosed. Both lesions were drained, and Streptococ-
cus anginosus group (SAG) was isolated from each culture.
Finally, the patient was discharged with only a slight decline
in his cognitive function. SAG is known for its abscess-
forming tendency. We should therefore perform a whole-
body scan when SAG is found (1). In addition, pyogenic
ventriculitis is life-threatening, so brain MRI is recom-
mended if an altered level of consciousness appears in a pa-
tient with liver abscess (2).
The authors state that they have no Conflict of Interest (COI).
１
Division of Gastroenterology and Hepatology, Digestive Disease Center, Kitano Hospital, Japan and
２
Division of Neurosurgery, Kitano Hospi-
tal, Japan
Received: June 29, 2018; Accepted: August 26, 2018; Advance Publication by J-STAGE: November 19, 2018
Correspondence to Dr. Shujiro Yazumi, s-yazumi@kitano-hp.or.jp
Intern Med Advance Publication DOI: 10.2169/internalmedicine.1758-18
2
References
1. Fazili T, Riddell S, Kiska D, Endy T, Giurgea L, Sharngoe C,
Javaid W. Streptococcus anginosus Group Bacterial Infections. Am
J Med Sci 354: 257-261, 2017.
2. Melanie BF, Robert LW, Sanjay M. CT and MR Imaging Features
of Pyogenic Ventriculitis. Am J Neuroradiol 22: 1510-1516, 2001.
The Internal Medicine is an Open Access journal distributed under the Creative
Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To
view the details of this license, please visit (https://creativecommons.org/licenses/
by-nc-nd/4.0/).
ⒸThe Japanese Society of Internal Medicine
Intern Med Advance Publication
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CT and MRI imaging features of pyogenic ventriculitis
Article
Full-text available
  • Oct 2001
Pyogenic ventriculitis is an uncommon manifestation of severe intracranial infection that might be clinically obscure. We hypothesized that determining characteristic imaging features of pyogenic ventriculitis in patients with appropriate risk factors might improve recognition of this severe infection. Review of the medical records from 1990 to 2000 revealed 17 cases (12 men, five women) that satisfied inclusion criteria of abscess (n = 3) and/or positive cultures or increased white cells and protein in ventricular (n = 12) or cisternal (n = 1) cerebrospinal fluid. In one case, the diagnosis of ventriculitis was based on the combination of bacterial growth in lumbar cerebrospinal fluid and follow-up imaging. Staphylococcus species and Enterobacter species were the most common organisms. Two neuroradiologists independently evaluated imaging studies for hydrocephalus, ventricular debris, periventricular attenuation or signal abnormality, ependymal enhancement, and signs of meningitis or abscess. Sixteen studies in 11 patients were performed after the intravenous administration of contrast material. Ventricular debris was detected in 16 (94%) of 17 cases and was irregular in 13 (81%) of 16 cases. Hydrocephalus was present in 13 (76%) of 17 cases. Periventricular hyperintense signal was present in most (seven [78%] of nine) cases with MR imaging and was most conspicuous on fluid-attenuated inversion recovery sequences. Ependymal enhancement was detected in seven (64%) of 11 cases in which contrast material was administered. Signs of meningitis (eg, pial or duraarachnoid signal abnormality or enhancement) were present in 13 (76%) of 17 cases. Three cases had imaging signs of abscess. Ventricular debris was the most frequent sign of ventriculitis in this series. An irregular level was characteristic of debris in ventriculitis. Hydrocephalus and ependymal enhancement were less frequent signs. Detection of ventricular debris might facilitate diagnosis of pyogenic ventriculitis, a potentially fatal infection, and thus permit appropriate therapy.
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Streptococcus Anginosus Group Bacterial Infections
Article
  • May 2017
  • AM J MED SCI
Background: The Streptococcus anginosus group (SAG) causes a variety of infections in adults. To better understand the burden of SAG infections and their associated morbidity and mortality, we conducted a retrospective analysis of these infections in adults at a tertiary care center. Methods: A retrospective review of all cultures positive for SAG in adults and a corresponding review of the patients' medical records were conducted at a tertiary care facility in central New York. Patients with these cultures during the period of January 2007-December 2011 were included. Demographic data, area of residence, clinical features and underlying illnesses, site of infection, length of hospital stay, antibiotic susceptibility and antibiotic therapy were recorded and analyzed. Results: There were 332 SAG cases; most patients were males (59%), mean age of 47 years and 84% lived in urban areas. Overall mortality was 3% with underlying conditions common such as diabetes (25%), hypertension (31%) and immunodeficiency (22%). Most of the infections were related to skin and soft tissue (72%) and polymicrobial (70%) with gram-negative anaerobes and Enterobacteriaceae commonly isolated with SAG. Conclusions: We present the largest study, thus far, reviewing the clinical presentation, management and outcome of infections due to the SAG of organisms. Notable findings from our study are the low mortality associated with SAG infection, and the propensity to present as a skin and tissue and polymicrobial infection. Our findings will assist clinicians in managing patients with SAG infections and recognizing that S anginosus may be one of several organisms responsible for infection.
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