Metallic cough and pyogenic liver abscess.
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.
Ala
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A
Department of Gastroenterology, North Middlesex Hospital, London, UK. a.ala@rfc.ucl.ac.uk
Safar-Aly
H
H
Millar
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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