title: Metallic cough and pyogenic liver abscess.
abstract: The curious symptom of a metallic cough in association with a pyogenic hepatic abscess should heighten awareness of a fistula. We describe a 78-year-old female with severe diverticular disease, on long-term steroid treatment for polymyalgia rheumatica. She developed a pyogenic liver abscess, treated initially by antimicrobial therapy, and subsequently drained by ultrasound and computed tomography-guided percutaneous transhepatic pigtail catheterization. This was complicated by a fistulous communication between the abscess cavity and the bronchus, confirmed by radiology. After repeated attempts at drainage and antimicrobial therapy the abscess cavity, including the hepatobronchial fistula, resolved.
authors.affiliation: Department of Gastroenterology, North Middlesex Hospital, London, UK. a.ala@rfc.ucl.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Ala
authors.forename: H
authors.initials: H
authors.lastname: Safar-Aly
authors.forename: A
authors.initials: A
authors.lastname: Millar
mesh_terms: D000368:Aged; D001983:Bronchial Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D003371:Cough / Q000209:etiology*; D016154:Digestive System Fistula / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D005260:Female; D005674:Fusobacterium Infections / Q000175:diagnosis* / Q000628:therapy; D016967:Fusobacterium nucleatum; D006801:Humans; D008100:Liver Abscess / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008107:Liver Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy