CRA4 A RARE CASE OF ESCHERICHIA COLI ESBL EMPYEMA WITH CONCURRENT LIVER ABSCESS: CASE REPORT

Wan Awatif WMZ1, Farhanah AK1, Muhammad Rusdi MN1, Muhamad Luqman Hakim AJ1, Tan CL1
1Department of Internal Medicine, Pendang Hospital, Kedah, Malaysia

Introduction:

Escherichia coli (E. coli) is a common bacterium in the intestinal flora that often causes urinary tract infections, cholecystitis, and traveller's diarrhoea. Isolation of E. coli from pleural fluid is rare.

Results:

We describe a 58-year-old gentleman with poorly controlled diabetes who presented with breathlessness associated with right chest pain and cough for one week without fever. On examination, he was afebrile, tachycardic, and tachypneic, requiring face mask oxygen at 5 L/min. Lung examination showed reduced breath sounds over the right lower zone. Other systemic examinations were unremarkable. A thoracic ultrasound revealed a multiseptated right pleural effusion. Right catheter drainage was placed, revealing empyema and a positive culture of ESBL E. coli. Since E. coli is a rare entity found in the pulmonary, an abdominal ultrasound was performed to look for possible sources of infection, which showed a multiloculated liver collection at segment VII. Computed tomography (CT) of the thorax and abdomen revealed a ruptured liver abscess complicated with right-sided empyema and a well-marked hypoechoic collection in segments VII and VIII of the liver that were percutaneously drained. The antibiotic was escalated to intravenous meropenem and was completed in 6 weeks with marked improvement of symptoms.

Conclusions:

We highlight a case of E. coli ESBL empyema, a rare presentation of extraintestinal E. coli infection. Thus, it necessitates an extensive workup to ensure the early recognition of liver abscesses, and prompt treatment is vital for a better clinical outcome.

Keywords: 

empyema, liver abscess, Escherichia coli ESBL