Difficult-to-Treat Hepatic Inflammatory Pseudotumor caused by Extrahepatic Inflammation Secondary to Peritonitis: A Case Report Highlighting the Therapeutic Potential of Nonsteroidal Anti-Inflammatory Drugs

Abstract

A female in her 50s developed a fever and right flank pain two months after undergoing surgery for peritonitis due to a perforated Meckel's diverticulum at another hospital. Laboratory tests and computed tomography revealed a liver abscess; however, antibiotic therapy was ineffective, and drainage was difficult because no liquefied component was observed. Liver biopsy revealed hepatic inflammatory pseudotumor (HIPT). Although symptoms temporarily improved, they recurred three months later, and a new lesion appeared in another hepatic segment, resulting in referral to our hospital. Imaging demonstrated a solid lesion, and a repeat biopsy confirmed the same diagnosis. Regular administration of nonsteroidal anti-inflammatory drugs (NSAIDs) caused transient improvement; however, recurrence occurred one month later with necrosis within the lesion. Aspiration confirmed the presence of pus, and drainage with antibiotic therapy led to clinical and radiological improvement. This case suggests that NSAIDs can improve inflammation secondary to HIPT-induced by peritonitis.