Intraperitoneal abscess formation spreading to the liver after endoscopic ultrasound-guided fine-needle aspiration for abdominal lymphadenopathy

Abstract

A 75-year-old woman was admitted to our hospital because of anemia and appetite loss. She had rheumatoid arthritis and was taking 1 mg of prednisolone and 150 mg of peficitinib orally. She was detected with lymphadenopathy, 18 mm in diameter, around the common hepatic artery with abdominal ultrasonography and abdominal computed tomography. Upper gastrointestinal endoscopy, colonoscopy, and chest computed tomography did not show any evidence of malignant disease. Using endoscopic ultrasound-guided fine-needle aspiration, the lymphadenopathy was punctured through the stomach. She was discharged 4 days after endoscopic ultrasound-guided fine needle aspiration. However, 3 days following discharge, she developed fever and was admitted again 14 days after the endoscopic ultrasound-guided fine-needle aspiration. Abdominal ultrasonography revealed that, at the site of the lymphadenopathy where the endoscopic ultrasound-guided fine-needle aspiration was performed, an intraperitoneal abscess was formed and spreading to the lateral segment of the liver, penetrating the hepatic capsule. Antibiotics failed to improve her condition. Percutaneous transhepatic abscess aspiration was performed 4 days following admission. Thereafter, her condition improved, and she was discharged 10 days after the transhepatic abscess aspiration. It should be noted that intraperitoneal abscess formation in the puncture can occur after ultrasound-guided fine-needle aspiration. Particularly in immunosuppressed patients such as our case, attention may be needed more than those with normal immune function.

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