Successful Conservative Management of Pyogenic Liver Abscess in a 13-Year-Old Male with Severe Inflammatory Response: A Case Report from a Tertiary Care Teaching Hospital

Abstract

Background: Pyogenic Liver Abscess (PLA) is an uncommon but potentially life-threatening infection in the pediatric age group. Delayed diagnosis may lead to septicemia, rupture of the abscess, or multi-organ dysfunction. Early diagnosis with prompt initiation of broad-spectrum intravenous antibiotics significantly improves clinical outcomes.

Case Presentation: A 13-year-old male presented with fever and right upper abdominal pain and was admitted to the Department of Pediatrics at Govt. Hospital, Meerut. Clinical examination revealed right upper quadrant tenderness with stable hemodynamic parameters. Laboratory investigations showed severe leukocytosis (40.5 ×10⁹/l), anemia (Hb 8.5 g/dl), markedly elevated C-reactive protein (>320 mg/l), hypoalbuminemia (2.9 g/dl), and mildly deranged liver enzymes. Blood and pus cultures remained sterile, while CBNAAT for Mycobacterium tuberculosis was negative. The patient received aggressive conservative management with intravenous fluids and broad-spectrum antibiotics, including Piperacillin-Tazobactam, Amikacin, Metronidazole, and Meropenem, along with supportive care. Serial investigations demonstrated progressive improvement in inflammatory markers and leukocyte counts.

Conclusion: Early recognition of pediatric liver abscess with timely initiation of broad-spectrum antimicrobial therapy resulted in favorable clinical improvement. This case highlights the importance of prompt diagnosis, close laboratory monitoring, and multidisciplinary management in preventing complications.