• Humans
• Tumor Necrosis Factor Inhibitors
• Liver Abscess/diagnosis
• Liver Abscess/therapy
• Azathioprine/therapeutic use
• Inflammatory Bowel Diseases/drug therapy
• Tumor Necrosis Factor-alpha

• Abdominal abscess
• Crohn’s disease
• amebic liver abscess
• aseptic abscess
• hepatic abscess
• hepatobiliary manifestations
• inflammatory bowel disease
• pyogenic liver abscess
• ulcerative colitis

• Aseptic abscesses
• Sarcoidosis

• Abdominal Pain/etiology
• Abscess/etiology
• Adult
• Canada
• Colitis, Ulcerative/complications
• Female
• Fever/etiology
• Humans
• Inflammatory Bowel Diseases/complications
• Male
• Retrospective Studies
• Splenic Diseases/etiology
• Weight Loss

Purulent skeletal muscle abscesses can occur in Crohn's disease. We report a case of a sterile seroma complicating percutaneous drainage of a purulent skeletal muscle abscess in Crohn's ileitis. We compare and contrast this case with a similar case we published earlier. We emphasize the importance of recognition and differentiation from a septic purulent abscess.

• acute generalized exanthematous pustulosis
• angioneurotic edema
• cutaneous reactions
• delayed adverse drug reactions
• iodinated contrast media reactions

Hepatocellular carcinoma most commonly occurs in patients with underlying liver disease or cirrhosis. We describe a case of hepatocellular carcinoma in a 34-year-old man with Crohn's disease treated with azathioprine and infliximab. The patient had no history of liver disease and a complete autoimmune and viral workup was unremarkable. Unfortunately, the patient developed widespread metastatic disease and passed away 5 months after his initial diagnosis. The mechanism of hepatocellular carcinoma in patients' with Crohn's disease is poorly understood and may include both autoimmunity and treatment-related complications. Previous case reports suggest the possibility of a concerning association between azathioprine therapy and the development of hepatocellular carcinoma in patients with Crohn's disease. Clinicians may consider early imaging in patients with Crohn's disease presenting with concerning symptomatology or abnormal liver enzymes, especially in those being treated with azathioprine alone or in combination with infliximab. Future research may help to uncover additional risk factors for this exceedingly rare diagnosis in this patient population.

Splenic abscesses in children are rare. In recent years aseptic abscesses have been recognized as a new disease entity, especially in adults.

We present a rare case of a 15 year old girl with aseptic abscesses, in whom antibiotic therapy comprising metronidazole and meropenem was partly beneficial in improving the patient’s clinical condition and inflammatory parameters. Eventually corticosteroid therapy led to complete and long lasting resolution of symptoms. Further diagnostic work-up revealed autoimmune thyroiditis, but no signs of inflammatory bowel disease.

Aseptic splenic abscesses should always prompt clinicians to initiate further diagnostics to determine a potential underlying condition and a regular follow-up. Anaerobic bacteria may play a role in the pathogenesis of the disease and besides corticosteroid treatment antibiotics covering anaerobes may be beneficial.

• Biliary tract disease
• Celiac disease
• Inflammatory bowel disease
• Liver disease
• Primary sclerosing cholangitis

Aseptic abscesses are an emergent entity and have been described in inflammatory bowel disease, especially in Crohn’s disease, and in other diseases. However, aseptic abscesses associated with Behçet’s disease are extremely rare. We report a Japanese male diagnosed with an incomplete type of Behçet’s disease who developed multiple aseptic abscesses of the spleen and liver. In 2002, the spleen abscesses were accompanied by paroxysmal oral aphthous ulcers and erythema nodosum. As the patient’s response to antibiotic treatment was inadequate, a splenectomy was performed. Severe inflammatory cell infiltration, largely of polymorphonuclear neutrophils, was observed without evidence of bacterial or fungal growth. Although the patient had no history of ocular symptoms or genital ulcers, a diagnosis of incomplete Behçet’s disease was made according to the Japanese diagnostic criteria because of the presence of paroxysmal arthritis and epididymitis since 2002. In 2005, multiple liver abscesses developed with right hypochondrial pain and seemed to be attributed to Behçet’s disease because the abscesses yielded negative results during a microbiologic investigation and failed to go into remission under antibiotic therapy. Oral prednisone (15 mg/d) was started in May 2006, and the abscesses dramatically disappeared 4 wk after treatment. Although the patient had a relapse of the liver abscesses in association with the tapering of prednisone, the augmentation of prednisone dosage yielded a response. The abscesses of the liver and spleen were strongly suggested to be attributed to Behçet’s disease. Clinician should be aware of the existence of aseptic abscesses as uncommon manifestations of Behçet’s disease.

• Behçet’s disease
• Aseptic abscess
• Spleen
• Liver
• Prednisone

• Abscess/diagnosis
• Abscess/etiology
• Abscess/therapy
• Anti-Bacterial Agents/therapeutic use
• Behcet Syndrome/complications
• Behcet Syndrome/diagnosis
• Behcet Syndrome/therapy
• Erythema Nodosum/etiology
• Humans
• Immunosuppressive Agents/therapeutic use
• Liver Abscess/diagnosis
• Liver Abscess/etiology
• Liver Abscess/therapy
• Male
• Predictive Value of Tests
• Prednisone/therapeutic use
• Splenectomy
• Splenic Diseases/diagnosis
• Splenic Diseases/etiology
• Splenic Diseases/therapy
• Stomatitis, Aphthous/etiology
• Tomography, X-Ray Computed
• Treatment Outcome
• Unnecessary Procedures
• Young Adult

A liver abscess in Crohn’s disease is a rare but important entity that is associated with a poor prognosis and high mortality when treatment is delayed. We report a case of successful liver segmentectomy for a methicillin-resistant Staphylococcus aureus liver abscess in a patient with Crohn’s disease under infliximab treatment.

A 31-year-old Japanese man, who had been treated with infliximab infusions for Crohn’s disease, was referred to our hospital presenting with an abrupt onset of high fever and an elevated white blood cell count and serum C-reactive protein level. Computed tomography revealed a liver abscess occupying segment 8. The limited effect of percutaneous transhepatic abscess drainage and antibiotics led us to perform radical resection of the abscess. The patient recovered quickly after surgery and the postoperative course was uneventful.

The present case suggests that surgical removal of an abscess should be considered for patients under immunosuppression or refractory to conventional treatment.