Symptoms and Management of Aseptic Liver Abscesses

ABSTRACT

Aseptic liver abscesses occur very rarely. Clinical guidelines on the management of the disease do not exist, and the diagnosis is challenging.

We screen MEDLINE and PUBMED databases for relevant case reports from inception to November 2022. Information on patient age, sex, initial symptoms, the extent of abscess formation, further diagnoses, treatment, and course of the disease is analyzed.

Thirty cases with sterile hepatic abscess formation are identified. In most patients (n=18), the spleen is affected as well. Patients typically present with fever, abdominal pain, and increased inflammatory values. Comorbidity with inflammatory bowel disease is very common (n=18) and is associated with a significantly younger age at the time of hepatic abscess development. In addition, many patients show autoimmune-mediated cutaneous, ocular, or arthritic rheumatoid manifestations. Histological examination of abscess material reveals neutrophilic infiltration. The majority of patients initially receive corticosteroid therapy. Furthermore, response to azathioprine, anti-TNF-α antibodies, and other immunomodulatory drugs is reported. Ten out of fourteen patients with a long-term follow-up (≥ 36 months) have at least one relapse of hepatic abscess formation.

Aseptic hepatic abscesses should be considered in the case of sterile punctures and non-response to antibiotics. Patients with aseptic liver abscesses have a high risk of recurrence warranting immunomodulatory maintenance therapy.

ZUSAMMENFASSUNG

Aseptische Leberabszesse treten sehr selten auf und das Fehlen klinischer Leitlinien erschwert Diagnosestellung und Behandlung.

Wir führten eine Datenbankrecherche in MEDLINE und PUBMED nach relevanten Fallberichten von Aufzeichnungsbeginn bis November 2022 durch. Angaben zu Patientenalter und -geschlecht, Symptomatik, Abszessausdehnung, weiteren Diagnosen, Behandlung und Krankheitsverlauf wurden analysiert.

Wir identifizierten 30 Fälle von sterilen Leberabszessen. Zumeist war die Milz ebenfalls betroffen (n=18). Die typische Symptomatik schloss Fieber, abdominelle Schmerzen und erhöhte Entzündungswerte ein. Als sehr häufige Komorbidität zeigte sich eine chronisch-entzündliche Darmerkrankung (n=18), welche mit jüngerem Erkrankungsalter assoziiert war. Zudem bestanden häufig autoimmunvermittelte kutane, ophthalmologische und arthritische rheumatoide Manifestationen. Bei der histologischen Untersuchung wurde oftmals eine Infiltration neutrophiler Granulozyten festgestellt. Nach initialem Ansprechen auf Glucocorticoide wurden im Verlauf Therapieerfolge unter Azathioprin, TNF-α-Inhibitoren und weiteren Immunmodulatoren berichtet. Bei 10 von 14 Patienten mit langfristiger Nachbeobachtung kam es zu mindestens einem Rezidiv.

Aseptische Leberabszesse sollten bei Leberrundherden ohne Keimnachweis und fehlendem Ansprechen auf Antibiotika in Erwägung gezogen werden. Bei hohem Rezidivrisiko erscheint eine immunmodulatorische Erhaltungstherapie gerechtfertigt.

Keywords

aseptic liver abscess - literature review - autoimmune inflammatory disease - treatment

Schlüsselwörter

aseptische Leberabszesse - Literatur-Review - entzündliche Autoimmunerkrankung - Behandlung

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