BACKGROUND

Tuberculosis (TB) has long been a recognized infectious disease contributory to worldwide mortalities. Most cases are from low- to middle-income countries, including the Philippines. Hepatobiliary TB comprises only a small portion of extrapulmonary TB. Tuberculous liver abscess (TLA) usually presents with nonspecific findings causing delay in the diagnosis. Due to this, further reports are needed for early detection along with timely treatment for future courses.

Presenting a 17-year-old male who came in with right upper quadrant abdominal pain associated with intermittent fever. The symptoms persisted and eventually progressed to abdominal distention, weight loss and jaundice. Initial laboratories were taken including an ultrasound finding of a complex lesion in the hepatic lobe. He was initially managed with empiric antibiotic therapy – Ciprofloxacin and Metronidazole, however, despite it, there was persistence of right upper quadrant pain, abdominal distention and jaundice. Due to this, further work-up was done with drainage of the abscess. Cultures were taken revealing tubercle bacilli along with other microbial growth. Antibiotics and antituberculosis medications sensitive to the microorganisms were started. With the noted improvement of jaundice and abdominal distention and resolution of pain and fever, he was discharged.

 Tuberculous liver abscess is an uncommon presentation of extrapulmonary tuberculosis in an
immunocompetent male with right upper quadrant abdominal pain and jaundice. Although TB is endemic in the
Philippines, this gastrointestinal involvement is often not immediately recognized. Thus, with any suspicion of liver abscess,
tuberculous (TLA) type should be included in the differentials for early diagnosis and management. 

Introduction: Sodium-glucose cotransporter-2 (SGLT2) inhibitors are cornerstone therapies for heart failure and diabetes, offering proven cardiorenal benefits. However, expanded use necessitates vigilance regarding adverse effects, particularly genitourinary infections. While mild cystitis is common, serious upper urinary tract infections remain rare and potentially life-threatening. We describe a case of renal abscess presenting as recurrent urinary tract infections (UTI) following SGLT2 inhibitor initiation, emphasizing the need for clinical vigilance. Case: A 69-year-old male with a significant cardiovascular history, including heart failure with reduced ejection fraction (HFrEF), hypertrophic cardiomyopathy with an implantable cardioverter-defibrillator for non-sustained ventricular tachycardia, diabetes mellitus, hypertension, and hyperlipidemia, presented with a 1-week history of right flank pain, dysuria, urinary frequency, and fever. Initial labs confirmed infection: leukocytosis (22.6 × 10³/ µL), markedly elevated CRP (200 mg/L), and bacteriuria. He was diagnosed with a UTI and started on IV Cefuroxime. This marked his third UTI admission in 5 months, following discharge just 3 weeks prior for septic shock secondary to UTI, establishing a relapsing pattern. Subsequent urine and blood cultures were unremarkable. Medication review revealed Dapagliflozin had been initiated for HFrEF 8 months ago. Following clinical improvement from each prior UTI episode, Dapagliflozin was consistently restarted. Despite an initial antibiotic response, symptoms recurred after discharge each time. The recurrent nature of his infections prompted a renal ultrasound revealing a large (5.3 × 7.5 × 7.4 cm), non-drainable, heterogeneously hypoechoic collection at the left kidney’s mid-lower pole, diagnostic of an early renal abscess. Conclusion This report highlights renal abscess as a rare and severe complication of SGLT2 inhibitor therapy. It serves as a critical reminder that recurrent or relapsing UTIs in patients on these agents should prompt immediate investigation with renal imaging to rule out deep-seated pathology rather than simple cystitis. While these drugs offer proven cardiorenal benefits, their role in promoting urological infections necessitates a cautious approach.
Abscess ; Sodium-Glucose Transporter 2 Inhibitors

A 53-year-old male with uncontrolled diabetes mellitus who presented with progressive scrotal swelling and straining was found to have a scrotal mass highly suggestive of scrotal abscess on inguinoscrotal ultrasound. Incision and drainage of abscess revealed a mass extending from the bulbous urethra. Subsequent urethrotomy revealed a large stone enclosed in a wide based urethral diverticulum. Urethral diverticulum (UD) is a rare urologic disease entity with a prevalence rate of 0.5 to 5% for both sexes. One complication of UD includes the formation of stone calculi which only occurs in 1% to 10% of all UD cases. UD calculi masqueraded by scrotal abscess has caused diagnostic dilemma as reported cases are often misdiagnosed. Furthermore, the lack of a standard guideline for surgical management of UD in males has led to individualization of the surgical technique done in reported cases. Only 2 other similar cases have been reported in literature worldwide.

OBJECTIVES: To study the clinical characteristics and risk factors of pyogenic liver abscess complicated by sepsis in children. METHODS: A retrospective analysis was conducted on the clinical data of 120 children with pyogenic liver abscess admitted from May 2004 to January 2024. According to the presence of sepsis, the children were divided into a sepsis group (82 cases) and a non-sepsis group (38 cases). The clinical characteristics of the two groups were compared, and risk factors associated with the occurrence of sepsis were identified. RESULTS: Among the 120 children with pyogenic liver abscess, 68.3% (82/120) had sepsis. Multivariate logistic regression analysis showed that fever, elevated white blood cell count, and decreased albumin level were closely associated with the occurrence of sepsis (P<0.05). Receiver operating characteristic curve analysis indicated that white blood cell count and albumin levels had significant predictive value for sepsis (P<0.05), and the combination of white blood cell count and albumin level showed higher predictive value for sepsis than the albumin level alone (P<0.05). CONCLUSIONS The clinical manifestations of children with pyogenic liver abscess complicated by sepsis are non-specific. Fever, elevated white blood cell count, and decreased albumin level are risk factors for sepsis in children with pyogenic liver abscess. Clinically, for children with unexplained fever and imaging suggestive of liver abscess, pyogenic liver abscess should be considered. If laboratory tests show elevated white blood cell count and decreased albumin level simultaneously, there should be a high level of suspicion for the development of sepsis.
Humans ; Liver Abscess, Pyogenic/blood* ; Male ; Female ; Risk Factors ; Retrospective Studies ; Sepsis/etiology* ; Child, Preschool ; Infant ; Child ; Leukocyte Count ; Logistic Models ; Adolescent ; Serum Albumin/analysis*

A middle-aged patient presented with persistent purulent discharge from a scalp incision five years after undergoing craniotomy with artificial dura mater implantation. The wound showed no significant improvement despite a month of systemic antibiotic therapy and local debridement. Subsequent superficial ultrasonography revealed complete separation of the artificial dura mater implant area from the surrounding flap tissue, with a loss of local blood supply. Based on these findings, the artificial dura mater was surgically removed, and a free skin flap transplantation was performed to successfully cover the wound. The wound was well-healed at the 10-month postoperative follow-up.
Humans ; Scalp/diagnostic imaging* ; Middle Aged ; Male ; Epidural Abscess/etiology* ; Ultrasonography ; Surgical Flaps ; Surgical Wound Infection/surgery* ; Dura Mater/surgery*

Objective:To discuss the clinical efficacy of low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess for the treatment of congenital pyriform sinus fistula （CPSF） in the acute inflammatory period of children. Methods:Clinical data of 30 patients with CPSF in the acute inflammatory period who received low-temperature radiofrequency ablation assisted by endoscopy under laryngoscope, combined with resection and drainage of cervical abscess, from January 2018 to December 2023 were reviewed. After the operation, patients were followed up closely at different stages. All patients underwent color Doppler ultrasound and electronic laryngoscopy, and the results were analyzed. Results:All 30 children successfully completed the surgery without pharyngeal fistula, dysphagia, perifistula, or distal fistula infection, and the incision in the neck healed well. The follow-up survey ranged from 6 months to 2 years, and no recurrences were observed. Conclusion:Low-temperature radiofrequency ablation assisted by endoscopy combined with resection and drainage of cervical abscess is a promising method for treating CPSF in the acute inflammatory period. It is less traumatic, simple, safe, has a significant curative effect, and a low recurrence rate. This approach can be used as a supplementary operation for CPSF in children and provides a new way for clinical treatment.
Humans ; Pyriform Sinus/abnormalities* ; Abscess/surgery* ; Drainage ; Fistula/congenital* ; Female ; Male ; Child ; Radiofrequency Ablation ; Treatment Outcome ; Postoperative Period ; Endoscopy ; Laryngoscopy ; Inflammation ; Child, Preschool

Objective:To explore the clinical characteristics and treatment methods of middle ear cholesteatoma with intracranial and extracranial complications as the first diagnosis. Methods:A total of 244 patients were initially diagnosed with intracranial and/or extracranial complications associated with middle ear cholesteatoma at the First Affiliated Hospital of Zhengzhou University from January 2015 to January 2022, and medical records were collected and retrospectively analyzed. Results:Among 244 patients with intracranial and extracranial complications of middle ear cholesteatoma, 203 cases had one complication, 34 cases had 2 complications, and 7 cases had 3 or more complications. One hundred and eighty-six cases presented labyrinthitis, 41 cases had peripheral facial paralysis, 27 cases had periauricular abscess, 12 cases had meningitis, 10 cases had brain abscess, 7 cases had sigmoid sinus lesions, 6 cases had epidural abscess, and 4 cases demonstrated hydrocephalus. Conclusion:The destructive nature of middle ear cholesteatoma can lead to intracranial and extracranial complications. The incidence rate of extracranial complications is highest for labyrinthitis. Patients with otitis media who complained dizziness should raise clinical suspicion for potential labyrinthitis. The second most prevalent extracranial complication is peripheral facial paralysis, and early facial nerve decompression surgery is critical for better recovery of facial paralysis symptoms. Brain abscess is the most common intracranial complications, which has the highest fatality rate. Clinicians should be alert to otogenic brain abscess. Otolaryngology and neurosurgery teams should cooperate and evaluate patients' middle ear lesions and brain abscess, and jointly develop personalized treatment plans.
Humans ; Cholesteatoma, Middle Ear/surgery* ; Retrospective Studies ; Facial Paralysis/etiology* ; Brain Abscess/diagnosis* ; Male ; Female ; Otitis Media/complications* ; Meningitis/etiology* ; Labyrinthitis/etiology* ; Adult ; Middle Aged ; Young Adult

This report presents a case of esophageal fistula with recurrent cervical abscess as the initial symptom. The patient underwent anterior cervical fracture reduction and internal fixation in 2021 due to trauma. In 2023, the patient received radiofrequency ablation for bilateral thyroid lobe lesions, after which recurrent cervical abscesses occurred over an 8-month period. Fiberoptic laryngoscopy with the biopsy channel insufflation method revealed a large esophageal fistula at the esophageal inlet. After removing the internal fixation plate, the patient received daily wound care, and serial fiberoptic laryngoscopy revealed spontaneous healing of the esophageal fistula. During the 1-year follow-up, no recurrence of cervical abscess was observed, and the esophageal fistula healed well.
Humans ; Abscess ; Recurrence ; Neck ; Female ; Adult ; Fracture Fixation, Internal

Objective:To analyze the etiology, diagnosis, treatment of cholesteatoma of temporal bone complicated with brain abscess. Methods:A total of 27 patients with cholesteatoma complicated with brain abscess admitted to the Peoples Hospital of Xinjiang Uygur Autonomous Region from January 2008 to January 2024 were collected, and their clinical characteristics and treatment methods were summarized. Results:Tow patients underwent modify radical mastoidectomy and eliminate abscess by pricking. The other patients underwent ear surgery after neurosurgical treatment of brain abscess. Among them, 19 cases underwent open craniotomy for brain abscess and 5 cases with small abscess were transferred to otorhinolaryngology for radical mastoidectomy after transcranial drainage. Only one patient died, the other patients had a good prognosis without recurrence. Conclusion:OBA is the most serious complication of temporal cholesteatoma with a high mortality rate, and MRI can assist in early diagnosis. Early treatment and multidisciplinary collaboration can improve the cure rate of the disease.
Humans ; Brain Abscess/therapy* ; Temporal Bone ; Cholesteatoma/therapy* ; Male ; Female ; Mastoidectomy ; Adult ; Middle Aged ; Magnetic Resonance Imaging ; Craniotomy

Palatal radicular groove is a developmental malformation of maxillary incisors, lateral incisors in particular, which often causes periodontal destruction. This paper reports a case of combined periodontal-endodontic lesions induced by palatal radicular groove, which was initially misdiagnosed as a simple periapical cyst. After root canal therapy and periapical cyst curettage, the course of disease was prolonged, resulting in the absence of buccal and maxillary bone plates in the affected tooth area. After the etiology was determined, the affected tooth was extracted and guide bone tissue regeneration was performed at the same time, followed by implantation and restoration at the later stage, leading to clinical cure. The palatal radicular groove is highly occult, and the clinical symptoms are not typical. If the abscess of the maxillary lateral incisor occurs repeatedly, and the abscess of the maxillary lateral incisor has not been cured after periodontal and root canal treatment, cone-beam computed tomographic and periodontal flap surgery should be considered.
Humans ; Incisor ; Radicular Cyst ; Abscess ; Tooth Root/abnormalities* ; Root Canal Therapy ; Maxilla ; Cysts