Gas Forming Pyogenic Liver Abscess Diagnosed by Point of Care Ultrasound.

Gas-forming pyogenic liver abscess (GFLPA) carries a high mortality rate. Early identification of the source of infection in sepsis results in better survival. Bedside point of care ultrasound (POCUS) can be used to help localize a source of infection. A 59-year-old man presented with systemic inflammatory response syndrome (SIRS) and was diagnosed with GFLPA on the initial encounter via clinical assessment and POCUS examination. After commencing antibiotics, optimal glucose control, adequate fluid resuscitation, and early infective source control, he achieved full recovery and was followed up in outpatient medical and surgical clinics. This case illustrates the role of POCUS as a diagnostic tool in sepsis and raises awareness among clinicians to recognize the features of GFLPA on POCUS.

Pneumorrhachis Secondary to Klebsiella pneumoniae Gas-Forming Paraspinal Abscess: A Case report and Review of Literature.

Pneumorrhachis is a rare entity, where air pockets are found in the spinal canal and the etiology can be categorized into traumatic and non-traumatic, the latter further categorized into spontaneous, iatrogenic, and associated with infections. Infective causes are often associated with gas-forming organisms and are associated with significant morbidity and mortality. Often the diagnosis is not suspected until imaging is done. We report the case of a 57-year-old man who presented with fever, backache, lower leg weakness, and dysuria. A computed tomography scan for evaluation of intra-abdominal sepsis incidentally showed pneumorrhachis affecting the thoracic and lumbar levels, gas-forming paraspinal abscess, prostate abscess, liver cirrhosis, and sigmoid colon carcinoma. Blood culture isolated Klebsiella pneumoniae. The patient recovered after six weeks of intravenous antibiotics followed later by sigmoid colectomy and chemotherapy. A literature review identified 63 cases of pneumorrhachis associated with infections and can be categorized into infections with spontaneous pneumorrhachis (predominantly respiratory tract infections), infections with pneumorrhachis (predominantly with emphysematous infections), and iatrogenic with infections and pneumorrhachis (predominantly postspinal interventions). Infections with pneumorrhachis occurred in older age groups and were associated with higher mortality compared to the other two categories.

Emphysematous Pyelonephritis

Urinary tract infection is very common and in most cases is self limiting even without treatment. However, in some cases, the infection may progress and leads to serious complication requiring admission and treatment. Emphysematous pyelonephritis is a rare but serious complication of urinary tract infection. The symptoms are similar to those seen in pyelonephritis and without radiological imaging; the diagnosis can be missed with serious consequence. In severe cases, nephrectomy may be indicated. We report a case of emphysematous pyelonephritis in a previously well obese 28 year old lady who was successfully managed with intravenous antibiotic. Her underlying risk factor was undiagnosed diabetes mellitus.

A Case of Post-Cesarean Endomyometritis Associated with Myometrial Gas Formation / 대한산부인과학회지

Postpartum endomyometritis is an important cause of maternal morbidity, especially after cesarean delivery. The management of postpartum endomyometritis is primarily medical with surgical intervention only occasionally required. But the gas forming abscess rarely happens, making the medical treatment difficult and needing emergency hysterectomy. We present a case of post-cesarean delivery endomyometritis complicated by intrauterine gas formation penetrating myometrium, which could not be managed by medical treatment, so finally needed emergency hysterectomy.

A Case of Gas-forming Scrotal Wall Abscess / 대한비뇨기과학회지

Gas-forming infections in the genitourinary tract are usually associated with diabetes mellitus, and emphysematous pyelonephritis is a common disease among them. However, gas forming infection occurring in the scrotum is extremely rare. We experienced a case of gas-forming scrotal wall abscess in a 45-year-old diabetic man, who showed clinical symptoms mimicking acute epididymo-orchitis.