Multiloculated Hepatosplenic Abscesses

To THE EDITOR—We note with interest the cases described by Apisarnthanarak et al. [1] detailing the radiological appearance of hepatic and splenic abcesses due to Burkholderia pseudomallei. We would like to report 2 differential diagnoses of multiloculated hepatosplenic abscesses; tuberculosis and liver abscess due to Klebsiella species. A 46-year-old woman presented with a 2-month history of fever following recent prolonged residency in China and India. Physical examination was unremarkable, except for the fever, and investigations revealed the presence of a single abscess in the liver and a multiloculated abscess in the spleen (figure 1). Aspirates of the liver abscess were obtained; Gram staining did not demonstrate organisms, and results of bacterial cultures were negative, but subsequent results of culture for acid-fast bacilli were positive for Mycobacterium tuberculosis. The patient was treated successfully with standard antituberculous therapy. Multiloculated splenic abscesses and liver abscess due to tuberculosis A 48-year-old diabetic man presented with a 2-week history of fever. He had not traveled to any areas where melioidosis is considered to be endemic. Physical examination revealed fever and tender hepatomegaly, and imaging demonstrated a multiloculated liver abscess (figure 2). Blood cultures grew Klebsiella pneumoniae; aspiration of the abscess was attempted but was unsuccessful. The patient was successfully treated with intravenous ceftriaxone. Multiloculated liver abscess due to Klebsiella pneumoniae Focal hepatosplenic abscesses are an unusual manifestation of tuberculosis [2], but tuberculosis of other organs is an important differential diagnosis of melioidosis in countries where it is endemic. Klebsiella species are increasingly recognized pathogens implicated in liver abscesses, especially in some countries where melioidosis is endemic, such as Taiwan and Thailand [3, 4]. It is important to confirm the diagnosis of melioidosis with culture of blood or aspirates, because the therapy of other potential causes of multiloculated abscesses may be significantly different. Potential conflicts of interest. A.C.C. and D.F.J.: no conflicts.