Hiccups : an uncommon presentation of pyogenic liver abscess

Pyogenic liver abscess (PLA) is a rare but potentially life-threatening disease. It often presents with nonspecific symptoms and laboratory abnormalities (1, 2), which may result in missed diagnoses at emergency departments. Herein, we would like to report an uncommon presentation of PLA, which led to delayed diagnosis and interventions, in a patient with long-term malnutrition and relative immunocompromised status. An 81-year-old man presented to our emergency department with persistent hiccups for 2 weeks and intermittent fever in recent 3 days. He had a history of pancreatic cancer experiencing pancreaticoduodenectomy two years ago and long-term malnutrition. Except tachycardia (126 beats per minute) and hypotension (88/42 mm Hg), initial evaluations revealed no other obvious abnormalities. Laboratory abnormalities showed an elevated creatinine level of 1.5 mg/dL and aspar-tate aminotransferase level of 75 U/L. Additionally, extremely high procalcitonin concentration of 82.79 ng/mL implied a severe bacterial infection. Under the impression of septic shock, the patient received resuscitation and vasoactive treatment, and then was admitted to our intensive care unit. However, his clinical condition worsened even though the empiric antibiotic with Tapimycin was promptly administrated since his arrival at emergency department.