A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver

Yong Jae Lee; Gwang Ha Kim; Do Youn Park; Suk Kim; Chang Jun Park; Tae Kyun Kim; Jung Hee Koh

doi:10.4166/kjg.2013.61.4.225

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Lee, Kim, Park, Kim, Park, Kim, and Koh: A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver

Case Report

Korean J Gastroenterol 2013;61(4):225-229.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.61.4.225

A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver

Yong Jae Lee, Gwang Ha Kim, Do Youn Park¹, Suk Kim², Chang Jun Park, Tae Kyun Kim, Jung Hee Koh

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

¹Department of Pathology, Pusan National University School of Medicine, Busan, Korea

²Department of Radiology, Pusan National University School of Medicine, Busan, Korea

Correspondence to: Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, 179 Gudeok-ro, Seo-gu, Busan 602-739, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: doc0224@pusan.ac.kr

Received 1 May 201225 August 2012 Accepted 28 August 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.

Keywords: Transarterial chemoembolization, Epidural abscess, Neuroendocrine tumors

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Fig. 1.

A mass (6.3×5.1 cm; arrow) with multifocal low attenuation areas was seen in the head of the pancreas at first visit.

Fig. 2.

Contrast-enhanced CT revealed hepatic metastatic lesions in the right lobe of the liver (arrow).

Fig. 3.

Liver biopsy showed (A) infiltration of round tumor cells which have uniform nuclei and monotonous in size (H&E, ×40). Tumor cell nests were strongly stained for CD 56 (B, ×200), synaptophysin (C, ×200), and pancytokeratin (D, ×200).

Fig. 4.

At 4 days after the transarterial chemoembolization, contrast-enhanced CT revealed a round-shaped necrotic lesion with abscess formation and air bubble (arrow).

Fig. 5.

(A, B) Spinal epidural abscess with spinal cord compression was seen at the L3/4 on a sagittal and axial contrast enhanced fat-sat T1 weighted MRI view (arrow). (C, D) Eight weeks after the treatment of antibiotics and operation, spinal epidural abscess was nearly subsided and spinal cord compression was improved on a sagittal and axial contrast enhanced fat-sat T1 weighted MRI view (arrow).

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ORCID iDs: Jung Hee Koh
https://orcid.org/http://orcid.org/0000-0002-6617-1449
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