Pediatric Infection and Vaccine

  • 제30권3호
  • /
  • Pages.165-172
  • /
  • 2023
  • /
  • 2384-1079(pISSN)
  • /
  • 2384-1087(eISSN)
대한소아감염학회 (The Korean Society of Pediatric Infectious Diseases)
권호 표지
DOI QR코드

DOI QR Code

건강한 소아에서 발생한 Prevotella intermedia에 의한 간농양 1예

A Case of Pyogenic Liver Abscess Due to Prevotella intermedia in an Immunocompetent Child

  • 김형석 (노원을지대학교병원 소아과) ;
  • 은병욱 (노원을지대학교병원 소아과)
  • Hyung-Suk Kim (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine) ;
  • Byung Wook Eun (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine)
  • 투고 : 2023.08.25
  • 심사 : 2023.11.05
  • 발행 : 2023.12.25
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

건강한 소아에서 화농성 간농양은 선진국에서는 드문 질환이지만 진단과 치료가 늦어진다면 치명적일 수 있는 질환이다. 전세계적으로 화농성 간농양의 가장 흔한 원인균은 Staphylococcus aureus이며 국내의 경우 Klebsiella pneumoniae가 가장 흔하지만, 혐기균에 의한 화농성 간농양도 매우 드물게 보고되고 있다. 발열과 우상복부 통증을 주소로 응급실에 온 14세 남아가 우상복부 압통을 보이고 백혈구 상승, 빈혈, 간효소치 상승을 보여 조영증강 복부컴퓨터단층촬영을 시행한 결과 간농양을 진단하였다. 환자는 2주간의 경피적 도관 배액술과 4주간의 항생제 치료 후 완쾌되었다. 간농양 배양검사에서 혐기균이자 구강 상재균인 Prevotella intermedia가 확인되었으나 감염의 근원이 치아조직 감염이라는 증거를 찾지는 못하였다. 본 증례와 같이 건강한 소아에서도 화농성 간농양이 발생할 수 있음을 염두에 두고 진단적 접근을 하는 것이 바람직하겠다.

Pyogenic liver abscess is a rare condition in healthy children in developed countries, but it can have severe consequences if diagnosis and treatment are delayed. Staphylococcus aureus is the most commonly identified cause of pyogenic liver abscess worldwide, while Klebsiella pneumoniae is the predominant causative agent in Korea. However, cases of pyogenic liver abscess caused by anaerobic bacteria have also been rarely reported. A 14-year-old boy presented to the emergency room with fever and pain in the upper right abdomen. He exhibited tenderness in the right upper quadrant, elevated white blood cell count, anemia, and elevated liver enzyme levels. Abdominal computed tomography with contrast revealed pyogenic liver abscess. The patient underwent percutaneous catheter drainage for two weeks and received a 4-week course of antibiotic therapy. Prevotella intermedia, an anaerobic bacterium commonly found in the oral flora, was isolated from the drained pus. However, no evidence was found suggesting that the infection originated from a dental source. This case highlights the importance of considering the possibility of pyogenic liver abscess even in otherwise healthy children.

키워드

과제정보

We would like to express our gratitude to Hye Young Han of Nowon Eulji Medical Center, Eulji University Library, for her technical editing of the manuscript.

참고문헌

  1. Mishra K, Basu S, Roychoudhury S, Kumar P. Liver abscess in children: an overview. World J Pediatr 2010;6:210-6.  https://doi.org/10.1007/s12519-010-0220-1
  2. Yeh PJ, Chen CC, Lai MW, Yeh HY, Chao HC. Pediatric liver abscess: trends in the incidence, etiology, and outcomes based on 20-years of experience at a tertiary center. Front Pediatr 2020;8:111.  https://doi.org/10.3389/fped.2020.00111
  3. Chung DR, Lee SS, Lee HR, Kim HB, Choi HJ, Eom JS, et al. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect 2007;54:578-83.  https://doi.org/10.1016/j.jinf.2006.11.008
  4. Ha J, Choi SP, Lee WH, Yoo SS, Kim HJ, Kim TH, et al. A clinical study on pyogenic liver abscesses: the changes in the clinical features during the recent 12 years. Korean J Med 2008;74:37-50.
  5. Lei WY, Chang WH, Shih SC, Liu CJ, Shih CH. Pyogenic liver abscess with Prevotella species and Fusobacterium necrophorum as causative pathogens in an immunocompetent patient. J Formos Med Assoc 2009;108:253-7.  https://doi.org/10.1016/S0929-6646(09)60060-7
  6. Johannsen EC, Sifri CD, Madoff LC. Pyogenic liver abscesses. Infect Dis Clin North Am 2000;14:547-63, vii.  https://doi.org/10.1016/S0891-5520(05)70120-3
  7. Tsai FC, Huang YT, Chang LY, Wang JT. Pyogenic liver abscess as endemic disease, Taiwan. Emerg Infect Dis 2008;14:1592-600.  https://doi.org/10.3201/eid1410.071254
  8. Pineiro-Carrero VM, Andres JM. Morbidity and mortality in children with pyogenic liver abscess. Am J Dis Child 1989;143:1424-7.  https://doi.org/10.1001/archpedi.1989.02150240046015
  9. Hansen PS, Schonheyder HC. Pyogenic hepatic abscess. A 10-year population-based retrospective study. APMIS 1998;106:396-402.
  10. Brook I, Fraizer EH. Role of anaerobic bacteria in liver abscesses in children. Pediatr Infect Dis J 1993;12:743-7.  https://doi.org/10.1097/00006454-199309000-00008
  11. Tweedy CR, White WB. Multiple Fusobacterium nucleatum liver abscesses. Association with a persistent abnormality in humoral immune function. J Clin Gastroenterol 1987;9:194-7.  https://doi.org/10.1097/00004836-198704000-00017
  12. Crippin JS, Wang KK. An unrecognized etiology for pyogenic hepatic abscesses in normal hosts: dental disease. Am J Gastroenterol 1992;87:1740-3.