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Chemotherapy-Induced Bone Marrow Suppression Complicated by Pyogenic Liver Abscess: A Case of Endogenous Endophthalmitis and a Literature Review
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  • Wei Jie Tao,
  • Ying Gao,
  • Jin Miao Wang,
  • Shou Jun Wang,
  • Ran Duan,
  • Jie Hao
Wei Jie Tao
Tianjin Union Medical Center Tianjin People's Hospital
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Ying Gao
Tianjin Union Medical Center Tianjin People's Hospital
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Jin Miao Wang
Tianjin Union Medical Center Tianjin People's Hospital
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Shou Jun Wang
Tianjin Union Medical Center Tianjin People's Hospital
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Ran Duan
Tianjin Union Medical Center Tianjin People's Hospital
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Jie Hao
Tianjin Union Medical Center Tianjin People's Hospital

Corresponding Author:[email protected]

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Abstract

Objective: In this article, we review the clinical data of a case involving chemotherapy-induced bone marrow suppression complicated by pyogenic liver abscess, leading to endogenous endophthalmitis (EE). By consulting the relevant literature, we comprehensively analyse and summarise the information, ultimately offering diagnostic and therapeutic insights for similar cases. Methods: This article presents the case of a 65-year-old female patient with breast cancer who developed bone marrow suppression during postoperative chemotherapy. Imaging examinations revealed the presence of a pyogenic liver abscess, and the patient subsequently experienced visual impairment. Following a thorough examination, the diagnosis indicated secondary EE resulting from a pyogenic liver abscess caused by Klebsiella pneumoniae. Upon hospitalisation, the patient underwent treatment with granulocyte colony-stimulating factor (G-CSF) to stimulate bone marrow haematopoiesis and she also received comprehensive systemic anti-infective therapy. Additionally, a pyogenic liver abscess drainage procedure was performed, coupled with intravitreal injection of antibiotics into the vitreous cavity of the affected eye. Results: After comprehensive systemic and local treatments, the patient’s laboratory parameters normalised. The volume of the pyogenic liver abscess reduced noticeably, allowing for the removal of the drainage tube. At the time of discharge, there was a reduction in intraocular inflammation. Nevertheless, complete loss of vision persisted in the affected eye. Conclusion: In patients with bone marrow suppression following chemotherapy, it is crucial to conduct liver imaging examinations to promptly exclude the possibility of bacterial pyogenic liver abscess. To prevent serious complications such as EE leading to blindness, timely pyogenic liver abscess drainage procedures must be performed. Administering antibiotics empirically for comprehensive systemic anti-infective therapy, along with localised ocular treatment, is also essential. This approach preserves vision as much as possible and enhances the overall prognosis for patients