Thread by @febrilepodcast

1/
Liver abscess is estimated to occur in about 1/3 of patients with CGD. In the episode, we discussed how a liver abscess may have distinct characteristics in the setting of CGD

#IDTwitter #IDMedED #PedsID @ID_fellows

PLA = pyogenic liver abscess

2/
PLA in CGD:
📌septate mass surrounded by a thick pseudocapsule
📌Inside=dense inspissated fluid.
📌Can be homogenously enhancing on imaging while small, but then develop mult locules separated by thick enhancing septations with intense halo/rim of enhancement around abscess

3/
Read more here about hepatic abscess in pts with CGD:
pubmed.ncbi.nlm.nih.gov/11882760/

pubmed.ncbi.nlm.nih.gov/16861554/ ➡️ look at Fig 3!

4/
Classically these abscesses were thought to almost always require surgery due to dense, caseous nature + difficult to drain fluid

While surgical resection is effective with low mortality ➡️ surgical morbidity can affect 1/2 of pts

5/
One approach of treatment of CGD-associated liver abscess is high dose steroids added to the targeted IV antibiotics, in attempt to modify underlying inflam response

ncbi.nlm.nih.gov/pmc/articles/P… 👉 compared CGD pts tx'd w/open surgery, percutan. drainage, or steroid management...

6/
268 CGD pts managed at NIH➡️88 with liver involvement➡️26 with records to examine questions

Results suggested nonoperative approaches are safe and can be effective in some patients

7/
ncbi.nlm.nih.gov/pmc/articles/P…

Pts treated with steroids+abxs had longer times to subsequent hepatic intervention than those managed by open surgical or perc drainage.

Steroid therapy was associated with improvement in liver function abnormalities and unassociated with mortality

8/
Hepatic abscess and liver complications of CGD can lead to portal hypertension, which has been associated with worse overall survival:

pubmed.ncbi.nlm.nih.gov/18439425/

9/
Did you find this helpful?!

There are more CGD learning nuggets coming next week, such as reinforcing the *must-know* organisms for CGD pts