[Meningitis and myelitis by hypervirulent Klebsiella pneumoniae]. / Meningitis y mielitis por Klebsiella pneumoniae hipervirulenta.

Invasive liver abscess syndrome caused by hypervirulent Klebsiella. pneumoniae is a rare disease. This type of K. pneumoniae is aggressive and invasive, despite its sensitivity profile. We report the case of a 62-year-old man with diabetes mellitus, who was admitted to our hospital with meningeal syndrome. Within 24 hours of admission, Gram negative bacilli were isolated blood and cerebrospinal fluid cultures, which were later identified as K. pneumoniae. Liver abscess was detected by computed tomography. Despite early antibiotic treatment, the patient developed back pain that prevented him from moving and right hemiparesis. Increased signal from the central region of the spinal medulla compatible with myelitis was identified by magnetic resonance, for which he received methylprednisolone 1 g/day for 5 days. The patient evolved favorably. Infections caused by hypermucoviscous K. pneumoniae are aggressive and invasive, and more common in men with a history of diabetes mellitus, as in this case. These infections require early antibiotic treatment and the search of metastatic infections.

El síndrome de absceso hepático invasivo causado por cepas hipermucoviscosas de Klebsiella pneumoniae es una enfermedad poco frecuente. Esta serovariedad de Klebsiella se caracteriza por ser agresiva e invasiva pese a su perfil de sensibilidad. Se presenta el caso de un varón de 62 años con antecedentes de diabetes mellitus, que ingresó a nuestro centro con síndrome meníngeo. A las 24 horas del ingreso se aislaron en hemocultivos y en líquido cefalorraquídeo (LCR) bacilos Gram negativos que luego fueron tipificados como Klebsiella pneumoniae. Se identificó la presencia de un absceso hepático mediante tomografía computarizada. Pese al tratamiento antibiótico instaurado de manera temprana, el paciente evolucionó con dolor dorsal que le impedía movilizarse y hemiparesia derecha. En la resonancia magnética nuclear de columna se identificó aumento de la señal de la región central de la médula espinal compatible con mielitis por lo cual recibió tratamiento con metilprednisolona 1g/día por 5 días consecutivos. El paciente evolucionó de manera favorable. Las infecciones por K. pneumoniae hipermucoviscosas son agresivas e invasoras y más frecuentes en varones con antecedentes de diabetes mellitus, como en este caso. Su control requiere de un tratamiento antibiótico temprano y búsqueda de focos a distancia.

Absceso hepático en Cali, Colombia / Liver abscess in Cali, Colombia

INTRODUCCIÓN: El absceso hepático (AH) es el tipo mas común de abscesos viscerales. Se estima que el perfil epidemiológico de esta enfermedad ha cambiado con el aumento de la resistencia de los microorganismos y el uso de nuevos medicamentos. OBJETIVO: Describir las características demográficas y clínicas de los pacientes hospitalizados con diagnóstico de AH en un hospital universitario del suroccidente colombiano. MÉTODOS: Se realizó un estudio observacional retrospectivo, en la Fundación Valle del Lili, Cali, Colombia. Se incluyeron pacientes mayores de 18 años con diagnóstico de AH hospitalizados entre 2011-2020. RESULTADOS: Se incluyeron 182 pacientes. La mediana de edad fUe 56 años (rango intercuartílico, 45-67) y 62,1% fueron hombres. El microrganismo mas común fue Klebsiella pneumoniae (17,6%). La mayoría requirió drenaje percutáneo (58,2%). El 58,8% tuvo un absceso único y 54,4% fue manejado en cuidados intensivos. El 7,1% de los pacientes falleció. Al comparar los casos que fueron manejados en cuidados intensivos vs. aquellos que no lo fueron, hubo más hepatomegalia (28,3 vs. 11,0%, p = 0,004), derrame pleural derecho (48,5 vs. 28,1%, p = 0,010), cirugía (42,4 vs. 13,4%, p < 0,001), falla terapéutica (22,2 vs. 7,3%, p = 0,007) y muerte (12,1 vs. 1,2%, p = 0,005) en los atendidos en UCI. CONCLUSIÓN: Las Enterobacterales son la principal causa de AH en nuestra población. La mortalidad ha disminuido, pero la hospitalización en cuidados intensivos sigue siendo alta.

BACKGROUND: Liver abscess (LA) is the most common type of visceral abscess. It is estimated that the epidemiological profile of this disease has changed with the increase in resistance and the use of new drugs. AIM: To describe the demographic and clinical characteristics of hospitalized patients with a diagnosis of LA in a university hospital in the southwestern region of Colombia. METHODS: A. retrospective observational study was conducted at Fundación Valle del Lili, Cali, Colombia. Patients older than 18 years with a diagnosis of LA hospitalized between 2011-2020 were included. RESULTS: A total of 182 patients were included. The median age was 56 years (interquartile range, 45-67) and 62.1% were men. The most common microorganism was Klebsiella pneumoniae (17.6%). The majority required percutaneous drainage (58.2%). A 58.8% had a single abscess and 54.4% were treated in ICU. A 7.1% of the patients died. When comparing cases treated in the ICU vs. those who did not, there was more hepatomegaly (28.3 vs. 11.0%, p = 0.004), right pleural effusion (48.5 vs. 28.1%, p = 0.010), surgery (42.4 vs. 13.4%, p < 0.001), therapeutic failure (22.2 vs. 7.3%, p = 0.007) and death (12.1 vs. 1.2%, p = 0.005) in patients treated in ICU. CONCLUSION: Enterobacterales are the main cause of LA in our population. Mortality has decreased, but intensive care hospitalization remains high.

Pyelo-hepatic abscess caused by staghorn stone infection: a case report.

BACKGROUND: The most common source of pyogenic liver abscess is biliary tract infection. Other less common routes include the spread of bacteria from distant foci. However, direct extension of a perinephric infection focus to the liver is extremely rare. CASE REPORT: The patient was a non-diabetic, immunocompetent, 29-year-old woman of mixed race ancestry with a history of recurrent urinary tract infections who was referred to our hospital because of an ultrasound-detected liver abscess. She was initially treated with metronidazole for 20 days at the referring institution for suspected amebic abscess without improvement. On admission to our center, she was febrile and complained of a dull right upper quadrant pain. A POCUS ultrasound suggested a pyogenic abscess, probably from a staghorn calculus infection. She received meroperem and amikacin for 22 and 10 days, respectively. Repeat hemocultures showed no growth, but urine cultures were positive for Proteus sp. Complete remission of clinical and imaging findings was observed under antibiotics. The patient was referred to the urology outpatient clinic to discuss the option of radical nephrectomy. CONCLUSION : This case underlines the high morbidity of staghorn calculi.

Acute Liver Infarct with a Superimposed Liver Abscess as a Consequence of Hypercoagulable State in a Patient with COVID-19 without Respiratory Manifestations.

COVID-19 infection has been associated, particularly in severely ill patients requiring hospitalization, with a hypercoagulable state. The case presented herein was a 66-year-old man with SARS-CoV-2 infection who did not have any respiratory symptoms. He presented with the following clinical manifestations: portal vein and hepatic artery thrombosis, liver infarction, and a superimposed abscess of the liver. In this case, early detection and the administration of anticoagulants and antibiotics led to a significant improvement within weeks of the diagnosis. We encourage physicians to be aware of COVID-19-associated hypercoagulable state and its potential complications, regardless of the acuity of the presentation or the absence of respiratory symptoms.

Changes in clinical and CT manifestations related to liver abscesses in patients with vs. without basic diabetes mellitus before and after CT-guided interventional therapy: An observational study.

PURPOSE: To explore differences in the changes of clinical and CT manifestations related to liver abscess before and after CT-guided interventional therapy between patients with and without Diabetes Mellitus (DM). MATERIALS AND METHODS: Fifty-eight consecutive patients with liver abscesses were retrospectively enrolled in this study. All patients underwent upper abdominal contrast-enhanced CT scans before and after CT-guided interventional therapy. They were divided into two groups including the DM group (n=30) and the Non-DM group (n=28) if the liver abscess occurred in patients with and without DM, respectively. The changes in the clinical and CT manifestations related to liver abscess after CT-guided interventional therapy in both groups were statistically analyzed. RESULTS: After CT-guided interventional therapy, the length of hospital stay, white blood cell recovery time and drainage tube removal time in the DM group were longer than in the Non-DM group (all p-values < 0.05). The incidence of postoperative complications in the DM group was higher than in the Non-DM group (p < 0.05). As shown on CT, the postoperative reduced percentage of maximum diameter of abscess cavity and the reduction rate of edema band surrounding the liver abscess in the DM group were smaller than in the Non-DM group (both p-values < 0.05). The time intervals of the previous characteristic changes on CT before and after interventional therapy in the DM group were longer than in the Non-DM group (all p-values < 0.05). CONCLUSIONS: The liver abscesses patients with DM could not have a faster recovery and better therapeutic effect than those without DM after the CT-guided interventional therapy.

Onfaloflebite em bezerra - tratamento com marsupialização da veia umbilical / Omphalophlebitis in a calf - treatment with umbilical vein marsupialization

Background: Omphalophlebitis is characterized as an omphalopathy that affects the umbilical vein. In these cases, ultrasonography can help identify the severity of abdominal lesions and guide the choice of treatment. Marsupialization of the umbilical vein is a surgical procedure indicated in cases where this vessel presents with purulent secretion up to the liver parenchyma. This report describes a case of omphalophlebitis in a calf treated by marsupialization of the umbilical vein. The preoperative and postoperative sonographic findings are also described. Case: A 4-day-old Holstein calf was attended at the Veterinary Hospital (HV) of the Universidade Federal de Goiás (UFG), Goiânia, Brazil. On physical examination, the animal was found to be apathetic, with tachycardia, tachypnea, hyperthermia, hyperemic mucous membranes, and moderate dehydration. An increase in volume was observed in the umbilical region, with local hyperthermia, firm consistency, and sensitivity to palpation. On deep palpation of the abdomen, a mass originating in the umbilical region and extending cranially was observed, leading to the suspicion of omphalophlebitis. Abdominal ultrasonography revealed external umbilical abscess and omphalophlebitis. Initially, conservative treatment with antibacterial and anti-inflammatory drugs was performed; however, there was no improvement in the clinical picture. Therefore, exploratory celiotomy was performed to remove the umbilical infectious focus. During the procedure, it was verified that the umbilical vein was dilated with a thickened wall until its insertion in the hepatic parenchyma, hence removal of the infected region through a ligature was not possible. Thus, marsupialization of the umbilical vein was performed to create a cutaneous opening for drainage of the purulent contents. In the postoperative period, antibacterial, anti-inflammatory, and analgesic drugs were administered. Dressing of the surgical wound and of the umbilical vein lumen was performed with topical polyvidone at 0.2%. Removal of the stitches was done 14 days postoperatively. Weekly ultrasonographic examinations were performed, which showed a gradual reduction in the diameter of the umbilical vein throughout the postoperative period. Thirty days after the surgical procedure, no further drainage of the purulent content was observed from the umbilical vein, and healing of the stump was demonstrated. After 7 months, a repeat ultrasonography was performed, revealing normal echogenicity and echotexture of the hepatic parenchyma and complete atrophy of the umbilical vein. Discussion: Umbilical vein marsupialization is a surgery rarely described in the literature, and no report has followed the evolution of a case by ultrasonography. The ultrasound examination of the umbilical structures was essential for the definitive diagnosis and choice of surgical treatment. Marsupialization of the umbilical vein was chosen due to the impossibility of ligature of this vessel, which presented with thickened walls and lumen filled with purulent content until its insertion into the liver. Postoperative monitoring via serial ultrasonography examinations allowed follow up of the evolution of the case and animal recovery. At the sonographic reevaluation after 7 months, the findings were unremarkable, indicating complete recovery of the patient. Umbilical marsupialization is a surgical technique that allows complete recovery of calves with severe omphalophlebitis. Ultrasonography is fundamental for the diagnosis of omphalophlebitis and in determining the best therapeutic protocol. Sonographic evaluation during the postoperative period allows follow-up of the progression of lesions in abdominal structures and helps in defining the prognosis.

Assessment of corn wet distillers grains fed to crossbred bulls on feeding behavior, rumen morphology, liver abscesses and blood parameters.

Corn ethanol production has been growing in Brazil in the last ten years, generating by-products to feedlot diets. This study evaluates the effects of the inclusion of low-fat corn wet distillers grains (LF-WDG) on feeding behavior, ruminal health, liver abscesses and blood parameters of F1 Angus-Nellore bulls feedlot finished. Our hypothesis is that evaluation of data from feeding behavior, rumen and liver health would help to explain animal performance. In this trail, one-hundred animals were fed for 129 days with diets containing amounts of 0 (control), 15, 30 and 45% of LF-WDG replacing corn grain and soybean meal. Evaluations of fluctuation of dry matter intake (DMI) were carried out. Additionally, feeding behavior data were assessed by monitoring (24-h period) the feeding, rumination, time spent eating (TSE), and time expended on other activities (resting and number of meals per day). Blood variables such as pH, bicarbonate, total CO2 content, and base excess in extracellular fluid (Beecf) were determined. After slaughter, rumen epithelium was classified according to the incidence of lesions (rumenitis) and abnormalities (papillae clumped), and samples were collected for morphology and histology evaluations. Moreover, livers were scored for severity of abscesses as follow: as unabscessed (0), one or two small abscesses (A-), two to four small active abscesses (A) or one or more large, active abscesses (A+). The DMI (kg/day) differed (P = 0.03) among treatments and there is a tendency of 15 and 30 LF-WDG (% DM) had lower %DMI fluctuation compared to 0 or 45%. The TSE increased linearly (P < 0.01) as the amounts of inclusion of LF-WDG increased. Moreover, neutral detergent fiber (NDF) intake, NDF consumption rate and NDF rumination efficiency increased linearly (P < 0.01) in response to LF-WDG feeding. The incidence of rumenitis tended (P = 0.08) to be greater at 45% LF-WDG, while keratin thickness decreased linearly in bulls fed LF-WDG (P < 0.01). The severity of liver abscesses (score A+) increased linearly (P = 0.02). Regarding blood parameters, only Beecf decreased linearly (P < 0.01) in response to LF-WDG feeding. Therefore, the hypothesis of the current study was confirmed. We previous reported that F1 Angus-Nellore bulls fed LF-WDG show greater weight gain (1.94 ± 0.09 kg/day) and final body weight (620 ± 18.8 kg) when compare to control (1.8 ± 0.09 kg/day and 602 ± 18.8 kg, respectively). Here, we conclude that inclusion of 15 to 30% LF-WDG in feedlot diets improved feeding behavior without impairing ruminal health and blood parameters, driving performance and weigh gain of crossbred bulls. However, bulls fed 45% LF-WDG had greater severity of liver abscesses.

Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Hypermucoviscous Klebsiella pneumoniae invasive syndrome in a patient with diabetes without liver abscess.

Klebsiella pneumoniae is part of the human gastrointestinal microbiota. It is also a well-known cause of community and nosocomial infections, involving mainly the lung and urinary tract. An invasive syndrome with liver abscess due to a new hypervirulent strain of K. pneumoniae was recently described. Several cases have been reported, mainly in Asia. Here, we show a case of a patient with an extrahepatic involvement affecting the lung and prostate.

The macroscopic and microscopic description of ruminal lesions in feedlot bovine / Descrição macroscópica e microscópica das lesões ruminais em bovinos confinados

Administration of diets rich in highly fermentable carbohydrates and low fiber content can cause an imbalance between the microorganisms in the rumen with consequent ruminal acidosis. This problem can cause lesions in the rumen wall, often progressing to rumenitis. The purpose of the present was to characterize macroscopic and microscopic ruminal lesions observed in confined feedlot cattle with claw lesions or liver abscess. A total of 1060 bovines were evaluated via postmortem examination. Claw lesions were identified in 88, liver abscess in 10, and macroscopic rumen lesions in 230 bovines; furthermore, 178 rumens were characterized with hyperkeratosis, 41 with hyperemia, 9 with ulcer, and 2 with neoplasia. The 98 bovines with claw lesions and liver abscess were selected for histopathological examination. Of these, macroscopic lesions were noted in 23 and microscopic lesions in 23 animals. Of the 23 animals that presented macroscopic lesions, 10 showed the same changes observed under microscopy. Seven cases of hyperkeratosis were diagnosed in the macro and microscopic evaluation. Of the 5 cases of hyperemia verified on macroscopy, 2 cases were identified via microscopy, and 1 case of ulcer identified through macroscopy and microscopy. The microscopic evaluation of the rumens allowed the identification of lesions in animals with claw lesions that did not present macroscopic rumen alterations.

O uso de dietas ricas em carboidratos altamente fermentáveis e com baixos teores de fibras pode ocasionar desequilíbrio entre os microrganismos do rúmen com consequente acidose ruminal. Esse problema pode resultar em lesões na parede do rúmen, evoluindo com frequência para formação de ruminite. O presente estudo objetivou caracterizar lesões ruminais macroscópicas e microscópicas, observadas em bovinos confinados que apresentavam lesões podais ou abscesso hepático. Avaliou-se 1060 bovinos pelo exame post mortem. Foram encontradas lesões podais em 88 animais, abscesso hepático em 10 e lesões ruminais macroscópicas em 230 bovinos, sendo caracterizado 178 rumens com hiperqueratose, 41 com hiperemia, 9 com úlcera e 2 com neoplasia. Os 98 bovinos com lesões podais e abscesso hepático foram selecionados para realização de exame histopatológico. Desses, foram encontradas lesões macroscópicas em 23 e, microscópicas, em 23 animais. Dos 23 animais que apresentaram lesões macroscópicas, 10 tiveram as mesmas alterações verificadas na microscopia. Foram diagnosticados 7 casos de hiperqueratose na avaliação macro e microscópica. Dos 5 casos de hiperemia verificados na macroscopia, 2 casos foram identificados na microscopia e um caso de úlcera identificado na macroscopia também foi identificado na microscopia. A avaliação microscópica dos rumens permitiu identificar lesões em animais com lesões podais que não apresentam alterações macroscópicas ruminais.

Genomic analysis of Burkholderia cenocepacia isolated from a liver abscess in a patient with cystic fibrosis.

Burkholderia cenocepacia complex is associated with high transmissibility, virulence, and poor prognosis in cystic fibrosis (CF) patients. However, extrapulmonary infections are rare. We investigated the genome of a B. cenocepacia IIIA isolated from a liver abscess in a Brazilian CF patient and compared it to strain J2315. The whole genome was sequenced, and contigs were annotated by Rapid Annotation using Subsystem Technology. The Pathosystems Resource Integration Center was used to map antimicrobial and virulence genes. The genomic island (GIs) analysis was performed using two prediction methods, and the presence of putative plasmids and insertion sequences (ISs) was investigated. The isolate was confirmed as B. cenocepacia IIIA to ST-28 (ET12 lineage). A total of 64 genes for antimicrobial resistance and 47 genes related to virulence were identified. Among the virulence factors, there was a predominance of factors related to the invasion mechanism, to the flagellar biosynthesis protein, and to the RNA polymerase sigma factor for flagellar operon (cdpA). Two IS families (IS3 and IS5) and only one plasmid were found. On average 56 GIs were predicted by at least one of the methods applied. Comparative analysis showed resistance mechanisms and virulence factors revealing invasive determinants used by B. cenocepacia IIIA (ET12) in the process of disease spread to other infection sites (extrapulmonary) of highly virulent strains in CF patients.

The first description of liver abscesses due to Salmonella enterica subsp. enterica in an African HIV-infected young woman: case report and review of the literature.

Salmonella is Gram-negative bacilli that cause a foodborne infections. When the disease occurs in patients living with HIV (PLWHA), salmonellosis is an AIDS defining illness. Here we describe the case of a 26-year-old HIV-infected female patient who was hospitalized for pain in the right upper quadrant of the abdomen, and whose explorations revealed a liver abscess due to salmonella enterica enterica that progressed well after needle aspiration and antibiotic treatment.

Ultrasonido en el punto de atención: reporte de un caso de absceso hepático / Point of care ultrasound diagnostic: a case report of a hepatic abscess

Resumen El ultrasonido en el punto de atención es una herramienta diagnóstica que ha tomado relevancia en el escenario intra y extrahospitalario, al tratarse de un estudio no invasivo que permite que los hallazgos clínicos se correlacionen directamente con los signos y síntomas que presenta el paciente. El objetivo del presente trabajo es evidenciar la utilidad clínica aplicada al caso de una paciente con una bacteremia persistente, en la cual se identificó el foco de infección por evaluación ultrasonográfica, para dirigir posteriormente la terapia. Presentamos un caso clínico en el que, por medio de esta herramienta, se estableció el diagnóstico de un absceso hepático insospechado clínicamente; se demuestra su utilidad clínica como extensión de la valoración médica especializada al obtener una experiencia favorable de su correcta utilización en un caso complejo.

Abstract Point of care Ultrasound is a diagnostic tool that has gained relevance in the hospital and outpatient setting, as it is a non-invasive study that allows direct correlation of clinical findings and the signs and symptoms that the patient presents. The objective of this paper is to show its clinical utility evident as applied to a female patient who had persistant bacteremia, in which the site of infection was identified through ultrasound evaluation. We present a clinical case whose diagnosis of hepatic abscess was possible by the use of ecography and shows its usefullness as an extension of specialized medical evaluation by showing a favorable experience of its correct use in a complex case. We present a clinical case in which the diagnosis of a clinically unsuspected liver abscess was obtained using this tool.

Ruptura espontánea de absceso hepático del lóbulo izquierdo en hemitórax derecho / Spontaneous rupture of liver abscess of the left lobe in the right hemithorax

Introducción: La extensión transdiafragmática del absceso hepático piógeno constituye un caso raro de empiema pleural. Es una enfermedad de progresión rápida y con altas tasas de mortalidad, cercanas al 100 por ciento si no se trata a tiempo. Objetivo: Describir el caso de una paciente con empiema pleural derecho, secundario a ruptura de absceso piógeno del lóbulo hepático izquierdo. Caso clínico: Paciente femenina de 70 años de edad que acude al cuerpo de guardia con fiebre, dolor abdominal, síndrome general. La tomografía computadorizada mostró absceso hepático el lóbulo izquierdo con licuefacción casi total y posteriormente presentó como complicación un empiema torácico derecho. La paciente fue tratada con drenaje con sonda pleural. A pesar de los tratamientos antibióticos y quirúrgicos oportunos la paciente fallece en shock séptico. Conclusiones: Se reporta un caso raro de empiema secundario a absceso hepático del lóbulo izquierdo. La demora de la paciente en acudir a instituciones de salud conllevó al fallecimiento de la paciente a pesar del tratamiento antibiótico y quirúrgico(AU)

Introduction: The transdiaphragmatic extension of the pyogenic liver abscess constitutes a rare case of pleural empyema. It is a rapidly progressive disease with high mortality rates close to 100 percent if it is not treated in time. Objective: To describe the case of a patient with right pleural empyema secondary to a ruptured pyogenic abscess of the left hepatic lobe. Clinical case: A 70-year-old female patient who came to emergency with fever, abdominal pain and general syndrome. The computed tomography scan showed a liver abscess in the left lobe with almost total liquefaction, and later a right thoracic empyema was a complication. The patient was treated with chest tube drainage. Despite timely antibiotic and surgical treatments, the patient died of septic shock. Conclusions: A rare case of empyema secondary to liver abscess of the left lobe is reported. The delay of the patient in going to health institutions led to the death of the patient despite antibiotic and surgical treatment(AU)