Liver Abscesses and Hyper IgM Syndrome
A 6-year-old girl presented with fever for 5 days and pain in right hypochondrium for 3 days. There was no jaundice or vomiting. On examination, she had a tender hepatomegaly. Other systems were normal. Investigations showed hemoglobin 6.9 gm/dL, WBC count 57,300/mm3, platelets 290,000/mm3, SGOT 39 IU/L, SGPT 28 IU/L, total proteins 7.9 gm/dL, albumin 2.9 gm/dL, and deranged prothrombin time and partial thromboplastin time. Ultrasound of abdomen showed abscess (size 6 × 5 × 4 cm) in right lobe of liver. Blood culture was negative. Child was treated with IV antibiotics: Ceftraixone and cloxacillin for 1 month and surgical drainage of abscess was done; subsequently, patient was given oral cloxacillin and cotrimoxazole for another 2 months and ultrasound showed complete resolution of abscess. Her HIV ELISA was negative and serum IgG was low (620 mg/dL (normal = 971-1746 mg/dL)), serum IgA was normal (118 mg/dL (normal = 75-178 mg/dL)), and serum IGM was elevated (229 mg/dL (normal = 66-153 mg/dL)). Her Nitroblue tetrazolium (NBT) was normal.