title: Uncommon cause of acute encephalopathy in liver cirrhosis.
abstract: A 49-year-old woman with a medical history of alcoholic cirrhosis status post-transjugular intrahepatic portosystemic shunt (post-TIPS) in 2012, and ongoing alcohol abuse, presented to the hospital, with haematuria. CT intravenous pyelogram (IVP) was normal except for 'a large intrahepatic cystic mass adjacent to the TIPS, causing intrahepatic biliary duct dilation'. The patient also presented with acute encephalopathy, jaundice, right upper quadrant abdominal pain and hyperbilirubinaemia (total bilirubin of 8.1 mg/dL with direct bilirubin of 3.0 mg/dL). She remained encephalopathic despite adequate treatment for alcohol withdrawal, hepatic encephalopathy and enterococcus urinary tract infection. MRI of the abdomen later confirmed presence of an obstructing biloma. The biloma, drained by CT-guided percutaneous drains, demonstrated an Escherichia coli and ESBL Klebsiella infection. The patient's encephalopathy completely resolved after treatment of the infected biloma. With adequate drainage, her hyperbilirubinaemia resolved to her post-TIPS baseline (total bilirubin of 3.7 mg/dL with direct bilirubin of 3.3 mg/dL).
authors.affiliation: Department of Community Health & Family Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Monique
authors.initials: M
authors.lastname: Dieuvil
authors.affiliation: Department of Community Health & Family Medicine, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: John
authors.initials: J
authors.lastname: Malaty
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001646:Bile / Q000382:microbiology*; D004927:Escherichia coli Infections / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D006501:Hepatic Encephalopathy / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000601:surgery; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents