title: Pyogenic liver abscess as the first manifestation of hepatobiliary malignancy.
abstract: BACKGROUND
  Pyogenic liver abscess (PLA) is commonly seen in patients in the Far East. Similarly, hepatobiliary neoplasms are also common. PLA as the initial manifestation of hepatobiliary neoplasms is extremely rare.
  
  
  METHODS
  Three patients with PLA were identified from the ward registion files and were retrospectively reviewed.
  
  
  RESULTS
  These patients (two men aged 74 and 80 years, and one woman aged 35 years) were treated (in the right lobe in two patients and in the left lobe in one) and subsequently followed up for 11-22 months. Two patients were diagnosed with hepatocellular carcinoma and one with metastatic cholangiocarcinoma. Two patients were subjected to biopsies showing features of inflammatory pseudotumor before a diagnosis of hepatocellular carcinoma. One patient underwent hepatic resection with good results. In the other two patients who declined any further interventions, one died a few weeks after diagnosis and the other is still alive on conservative treatment.
  
  
  CONCLUSIONS
  This series of cases highlights the importance of considering underlying hepatobiliary malignancies in patients with PLA and a close follow-up necessary for non-resolving hepatic lesions.
authors.affiliation: Gastroenterology Unit, Department of Medicine, Raja Isteri Pengiran Anak Saleha (RIPAS) Hospital, Bandar Seri Begawan BA 1710, Brunei Darussalam. chongvuih@yahoo.co.uk
authors.forename: Vui Heng
authors.initials: VH
authors.lastname: Chong
authors.forename: Kian Soon
authors.initials: KS
authors.lastname: Lim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D001653:Bile Ducts, Intrahepatic; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D018281:Cholangiocarcinoma / Q000150:complications*; D004927:Escherichia coli Infections / Q000150:complications; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000209:etiology*; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D012189:Retrospective Studies