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A shadow of doubt
Wycombe Hospital, High Wycombe, Bucks, UK
Correspondence to:
Dr A S McIntyre, Wycombe Hospital, Queen Alexandra Road, High Wycombe HP11 2TT, UK; alistair.mcintyre@buckshosp.nhs.uk
| The first 150 words of the full text of this article appear below. |
CLINICAL PRESENTATION
A 69-year-old female patient with a history of ischaemic heart disease and a laparoscopic cholecystectomy 4 years previously was admitted with a 6 month history of fatigue, vague right upper quadrant pain, fevers and night sweats. Initial investigations revealed an erythrocyte sedimentation rate (ESR) of 101 mm/h, white cell count 11.1x109/litre (neutrophils 7.8x109/litre) and normal liver function. An ultrasound scan (USS) elicited a fluid collection adjacent to her liver, which when drained revealed pus. Antibiotics were given to cover the cultured coliform. Initial differential included parapneumonic effusion or abscess, or hepatic abscess. Ongoing symptoms 3 months later necessitated a computed tomography (CT) scan of her abdomen when a recurrent collection was drained. A lactose-fermenter coliform bacterium, sensitive to co-amoxiclav/amoxicillin–clavulanate, was isolated from the aspirant. She was treated with co-amoxiclav/amoxicillin–clavulanate and discharged. The collection had resolved on USS. The patient re-presented 8 days later with
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