title: Life-threatening emphysematous liver abscess associated with poorly controlled diabetes mellitus: a case report.
abstract: BACKGROUND
  Emphysematous liver abscesses are defined as liver abscesses accompanied by gas formation. The fatality rate is extremely high at 27%, necessitating prompt intensive care.
  
  
  METHODS
  The patient was a 69-year-old Japanese man with type 2 diabetes. He visited the emergency outpatient department for fever and general malaise that had been ongoing for 2 weeks. Abdominal computed tomography revealed an abscess 5 cm in diameter accompanied by gas formation in the right hepatic lobe. Markedly impaired glucose tolerance was observed with a blood sugar level of 571 mg/dL and a glycated hemoglobin level of 14.6%. The patient underwent emergency percutaneous abscess drainage, and intensive care was subsequently initiated. Klebsiella pneumoniae was detected in both the abscess cavity and blood cultures. The drain was removed 3 weeks later, and the patient was discharged.
  
  
  CONCLUSIONS
  Emphysematous liver abscesses are often observed in patients with poorly controlled diabetes, and the fatality rate is extremely high. Fever and malaise occasionally mask life-threatening infections in diabetic patients, necessitating careful examination.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan. yuichitakano1028@yahoo.co.jp.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Takano
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Masafumi
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Niiya
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakanishi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Hanamura
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Asonuma
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Yamamura
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Kuniyo
authors.initials: K
authors.lastname: Gomi
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kuroki
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Naotaka
authors.initials: N
authors.lastname: Maruoka
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Inoue
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa, 227-8501, Japan.
authors.forename: Masatsugu
authors.initials: M
authors.lastname: Nagahama
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000175:diagnosis* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004646:Emphysema / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis*; D007711:Klebsiella pneumoniae / Q000472:pathogenicity*; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis* / Q000209:etiology; D008297:Male
keywords: Diabetes mellitus; Emphysematous liver abscess; Gas-forming pyogenic liver abscesses