Multiple recurrent liver abscesses in an immunodeficient patient

Abstract

Multipli recidivirajući jetreni apscesi su rijedak klinički entitet koji može predstavljati veliki dijagnostički i terapijski problem. Prikazali smo bolesnika koji je zbog septičnog stanja i recidivirajućih multiplih jetrenih apscesa u periodu od 1999. – 2007.god. višekratno liječen u više općih i kliničkih bolnica u Hrvatskoj. Učinjenom dodatnom imunološkom obradom dokazana je u prvom redu smanjena mikrobicidna aktivnost granulocitnih i monocitnih fagocita. U našem radu pokazali smo da se kod recidivirajućih multiplih apscesa jetre mora misliti na poremećaje u procesu fagocitoze, te je u takvih bolesnika u prvom redu potrebno uraditi funkcionalne testove fagocitoze, ali i T- i B-limfocita i NK-stanica. Primjena intravenskog imunoglobulina, koji ima ulogu u stimulaciji respiratornog praska i posljedično mikrobicidne aktivnosti, može smanjiti broj recidiva i povoljno utjecati na tijek bolesti.Multiple recurrent liver abscesses are uncommon clinical entity that can represent a significant diagnostic and therapeutic problem. We describe a patient who was, due to septic conditions and recurrent multiple hepatic abscesses, repeatedly treated in a number of general and clinical hospitals in Croatia in the period from 1999 to 2007. Additional immunological tests demonstrated a reduced microbicidal activities of granulocytes and monocytic phagocytes. Our paper shows that in patients with multiple recurrent liver abscesses, possible deficiencies in the process of phagocytosis have to be considered, and functional tests of phagocytes, T- and B-lymphocytes as well as NK-cells need to be performed. The administration of intravenous immunoglobulin, which has a role in stimulating the respiratory burst activity and, consequently, microbicidal phagocytic activity, can reduce the number of relapses, and favorably affect the course of disease