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DOI: 10.1055/a-0829-7017
Polymikrobielle Leberabszesse und Pleuraempyem bei einem 40-jährigen Mann nach Zahnextraktion und geschlossener Parodontitis-Behandlung: Ein Fallbericht
Polymicrobial liver abscesses and pleural empyema in a 40-year-old male after tooth extraction and closed periodontal treatment: A case reportPublication History
19 September 2018
27 December 2018
Publication Date:
13 May 2019 (online)
![](https://www.thieme-connect.de/media/zfg/201905/lookinside/thumbnails/zfg-0072_10-1055-a-0829-7017-1.jpg)
Zusammenfassung
Wir berichten über einen 40-jährigen Patienten, der sich mit Fieber, Druckschmerz im rechten Oberbauch, atemabhängigen rechtsseitigen Thoraxschmerzen und akuter Dyspnoe vorstellte. Bildgebend wurden größere Leberabszesse sowie ein ausgedehntes rechtsseitiges Pleuraempyem nachgewiesen. 16 Wochen zuvor hatte sich der Patient einer Zahnextraktion aller 3. Molaren (18, 28, 38, 48) und eines 1. Molaren (46) sowie einer systematischen geschlossenen Parodontitis-Behandlung unterzogen. Im Pleura- bzw. Leberabszesspunktat wurden vier verschiedene Spezies der physiologischen Mikrobiota der Mundhöhle nachgewiesen (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). Ein zugrundeliegender Immundefekt war nicht nachweisbar. Unter sonografisch gesteuerter Leberabszessdrainage, operativer Versorgung des Pleuraempyems mittels Video-assistierter Thorakoskopie (VATS) und Einlage von Thorax-Saug-Drainagen sowie gezielter antibiotischer Therapie kam es innerhalb von 6 Wochen zur vollständigen Ausheilung. Der Fallbericht veranschaulicht relevante Infektionsrisiken größerer zahnärztlicher Interventionen und diskutiert die derzeitigen Empfehlungen zur Durchführung einer periinterventionellen antimikrobiellen Therapie in den zahnärztlichen Leitlinien. Wichtig erscheint vor allem eine gute klinische Nachbeobachtung betroffener Patienten.
Abstract
We report on a 40-year-old patient who presented with fever, right upper abdominal pain, right-sided chest pain and acute dyspnea. Imaging revealed several liver abscesses, as well as extensive right pleural empyema. Sixteen weeks previously, the patient underwent tooth extraction of the third molars (18, 28, 38, 48) and a first molar (46), and systematic closed periodontitis treatment. Four different species of the physiological microbiota of the oral cavity were detected in the pleura or liver abscess punctate (Streptococcus anginosus, Streptococcus constellatus, Actinomyces odontolyticus, Prevotella denticola). An underlying immune defect was ruled out. Ultrasound-guided drainage of liver abscesses and surgical treatment of pleural empyema by video-assisted thoracoscopy (VATS) and insertion of thoracic suction drains was performed, accompanied by targeted antibiotic therapy. Over a course of 6 weeks, the patient recovered completely. The case report illustrates severe infectious side effects of major dental interventions, and it critically summarizes current dental guideline recommendations on peri-interventional antimicrobial therapy. Therefore, a good clinical follow up after major tooth extractions is imperative.
Schlüsselwörter
pyogener Leberabszess - Pleuraempyem - Streptococcus constellatus - Streptococcus anginosus - Actinomyces odontolyticus - Prevotella dentolytica - Streptococcus anginosus-Gruppe (SAG) - apikale Parodontitis - AntibiotikaKey words
pyogenic liver abscess - pleural empyema - Streptococcus constellatus - Streptococcus anginosus - Actinomyces odontolyticus - Prevotella dentolytica - Streptococcus anginosus group (SAG) - apical parodontitis - antibiotics* geteilte Erstautorenschaft.
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