Liver abscess

• In people with CGD, the immune system does not work properly. As a result, people with CGD experience frequent infections from bacteria and fungi. Due to these infections, abscesses may develop in the livers of people with CGD. A type of bacteria called ‘Staphylococcus aureus’ is the most common cause of liver abscesses, although other bacteria or even fungi can be responsible. Additionally, in people with CGD, inflammation may be present around the abscess.

Both children and adults with CGD can get liver abscesses. They can vary in size. Liver abscesses can be quite hard to detect, because they don’t always have clear symptoms. However, some of the things to look out for are:

• Feeling generally unwell
• Feeling very tired and ‘floppy’
• Loss of appetite
• Weight loss
• Tummy or back pain
• A fever – perhaps low to start with (37.5–37.9 Celsius) and then higher (38–40 Celsius)
• Nausea or vomiting
• Dark-coloured urine
• Yellow-coloured skin or eyes (known as ‘jaundice’)

Having these symptoms doesn’t necessarily mean you have a liver abscess – they can indicate many other conditions and infections too. It is important to talk to your doctor if you experience these symptoms, so that the doctor can establish a definite diagnosis.

Liver abscesses can be serious, making you feel very unwell. They can also cause pain and fatigue. They need to be treated promptly and effectively. Liver abscesses can take quite a long time to get better. But with the right treatment, people normally make a full recovery.

If you have a suspected abscess, your doctor will examine your stomach to see if your liver is larger and harder than usual. It may feel tender when they press your liver.

The doctor will then send you for an ultrasound scan of the area around your stomach, intestines and liver. This is a very simple and quick way to look for abscesses, and to see how big they are. It is not unusual to have one larger abscess and some smaller ones. Sometimes two small abscesses join together to form a larger one.

You may need further scans, such as a CT scan or an MRI scan, to get more detailed information about the abscess. The scan which your doctor chooses to do will depend on your situation.

Sometimes, it can be important to try and confirm which bacteria or other sort of germ is causing the abscess. This information helps determine the best treatment approach. To do this, a doctor or nurse can take some of the pus from the abscess, using a fine needle inserted into your abdomen. Additionally, a blood test can sometimes help to understand which bacteria may cause the abscess

The liver abscesses that are seen in people with CGD are a bit different from those in people without CGD. Therefore, the treatment options for people with CGD who have liver abscesses are also a bit different than for other people.

Antibiotics

As liver abscesses are caused by bacteria or fungi, doctors will usually start treatment with a combination of antibiotics and occasionally anti-fungal medication. Initially, these medications are given ‘intravenously’ (into your veins) using an injection or ‘drip’ (which means that a fluid with medicine slowly goes through a tube into your vein). The purpose of this treatment is to deal with the bacteria that cause the abscess. This treatment can take a few weeks to a few months. The medicines are given every day and, depending on the drugs being used, probably several times each day. How long it takes to receive the drugs depends on the situation, but an intravenous treatment can take approximately 30 minutes.

If you have a liver abscess, you will usually need to stay in hospital for quite a long time, for example if your antibiotics are given intravenously. Additionally, you will need to be checked regularly to see if your abscess is getting better. However, once you feel a little better, it’s often possible to go home. You can then get your medicines from a community nurse at home, or from the hospital as a day patient. Sometimes it is possible to train people with CGD or their family members to give antibiotics at home without help from a doctor or nurse. You can discuss taking medicines at home with your medical team.

Sometimes, doctors may insert a special tube (often called a ‘central line’) into your arm, neck or chest to make it easier to get the antibiotics into your body. A central line is different from a drip, because a central line is very long and goes all the way to a vein near your heart. A central line can also stay in place for several months. Doctors can also use it to take blood, as people with abscesses need tests frequently. Central lines are removed as soon as they are no longer needed. After some time, it will be possible to start taking antibiotics by mouth, but you may need to take these for several months.

Corticosteroids

‘Corticosteroids’, sometimes just called ‘steroids’, are a type of medication that help with inflammation in different diseases. Your doctor will usually give you steroids as well as antibiotics. This is because researchers have found that using corticosteroids in combination with antibiotics helps people with CGD who have liver abscesses to improve more quickly and to avoid surgery. Corticosteroids can come with side effects that your doctor should discuss with you.

Pus drainage
Sometimes, a doctor may choose to ‘drain’ the abscess, which means they take out the fluid or pus from the abscess. Draining the pus from a liver abscess can make it easier for antibiotics to work. A doctor will put a needle through your skin into the abscess in your liver. Then, the doctor can take the pus out of the abscess. To know the exact location of the abscess, a doctor can use CT or MRI scans. Occasionally, an abscess will need to be drained on more than one occasion.

It is not always possible to drain abscesses with a needle. Especially in people with CGD, drainage with a needle can be challenging. Some abscesses may not have any liquid pus inside, and instead they may have thick, semi-solid pus. The abscesses may also be difficult to reach.

Surgical removal

Rarely, a doctor may suggest removing the abscess using surgery. After surgery, you will likely receive antibiotics for a few weeks to fully treat the abscess. It depends on a person’s situation whether surgery is the right choice. As with all surgeries, removing liver abscesses can come with risks. Your medical team can talk about the steps of this surgery with you in more detail, as well as the risks and benefits specific to you.

Abscesses can upset the liver. Blood tests (called ‘liver function tests’ or ‘LFTs’) will show if there are any problems with the liver. Results of blood tests usually go back to normal once the abscesses are better and the liver becomes softer and goes back to its normal size.

The scars left by the abscesses are likely to remain visible on X-rays and scans for some time (even years). However, abscesses rarely cause any long-term damage. After you have been treated for liver abscesses, your doctor may want to keep checking in on you to see how you are doing and to prevent any new abscesses from forming. As liver abscesses can re-appear after treatment, it is important to keep an eye out for any symptoms of a liver abscess you may feel.