Pyogenic Liver Abscess Caused by Methicillin-Susceptible Staphylococcus aureus in a 21-Year-Old Male.

Liver abscesses are the most common types of visceral abscesses. Pyogenic liver abscesses, a particular type of liver abscesses, are uncommonly encountered. We present a rare case of pyogenic liver abscess caused by methicillin-susceptible Staphylococcus aureus in a young man. A 21-year- old man presented from prison to the hospital with fever, nausea, vomiting, diarrhea, and abdominal pain for five days. Labs were significant for leukocytosis with predominant neutrophilia and elevated liver enzymes. CT abdomen with contrast revealed an 8.4 cm multiloculated right hepatic mass extending to the kidney. Patient was started on broad spectrum antibiotics, given septic presentation. Peripheral blood cultures returned positive for methicillin-susceptible Staphylococcus aureus (MSSA). The culture from percutaneous drainage also revealed MSSA. He received a total of four weeks of IV Nafcillin therapy along with drainage of his abscess via percutaneous catheter. Follow-up revealed clinical resolution. This case highlights the importance of obtaining an aspirate from the liver abscess to better guide treatment strategy. Clinicians must consider broadening antibiotic coverage to include gram-positive organisms if the patient presents with severe illness and risk factors for Staphylococcus aureus infections.

Synthetic Cannabinoid Abuse and a Rare Alpha-1-Antitrypsin Mutant Causing Acute Fulminant Hepatitis: A Case Report and Review of the Literature.

Synthetic cannabinoids (SCs) abuse is on the rise because they are easily obtained over the counter; they are potent psychoactive compounds and routine drug testing does not detect them. As their abuse is on the rise, so are their detrimental side effects; however, the occurrence of acute hepatitis due to SCs abuse has been reported only once before. In this case, testing revealed that the patient was also heterozygous for alpha-1-antitrypsin (A-1-AT) with the phenotype of PI⁎EM. This mutant phenotype has never been reported as a cause of A-1-AT disease and the abuse of SCs in a patient with this phenotype has also never been reported. This case illustrates the possible need to expand routine drug testing for SCs and consider A-1-AT phenotyping in certain clinical scenarios.

The Aftermath of a Hepatic Artery Aneurysm-A Rare Etiology of Biliary Obstruction!

BACKGROUND: Hepatic artery aneurysms (HAAs) constitute 14% to 20% of visceral artery aneurysms. Most HAAs are asymptomatic. Although rare, obstructive jaundice due to external bile duct compression or rupture of the HAA into the biliary tree with occlusion of the lumen from blood clots has been reported. CASE PRESENTATION: A 56-year-old white man presented to an outside hospital with symptoms of obstructive jaundice, including abdominal pain and yellowing of the skin. Imaging showed a large HAA. Patient was transferred to our hospital where an endoscopic retrograde cholangiopancreatography with biliary stenting was performed. This was followed by coil embolization of the HAA with improvement in symptoms and liver chemistries. CONCLUSIONS: Most clinicians agree that management of HAA is highly variable and depends on clinical presentation and anatomic location. Biliary stenting provides temporary relief for patients with obstructive jaundice. Definitive options include open aneurysmal repair versus endovascular therapy. Hepatic artery aneurysms represent a significant risk for hemorrhage and therefore must be addressed promptly once discovered.

Diabetic Ketoacidosis-induced Hypertriglyceridemic Acute Pancreatitis Treated with Plasmapheresis-Recipe for Biochemical Disaster Management.

Diabetic ketoacidosis (DKA)-induced hypertriglyceridemia causing pancreatitis is an interesting phenomenon that has rarely been reported in literature. Plasmapharesis is a well known treatment modality for hypertriglyceridemia-induced pancreatitis. We report a patient with DKA-induced hypertriglyceridemic acute pancreatitis treated successfully with plasmapharesis.