{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T08:16:37Z","timestamp":1787991397041,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":240,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004769","name":"Universit\u00e0 degli Studi di Pavia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004769","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Hepatology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malignant and benign hepatic diseases may both present with systemic symptoms and necrotic liver cavities. Although rare and reported predominantly in East Asia, pyogenic liver abscess (PLA) can represent the initial manifestation of hepatocellular carcinoma (HCC), as necrotic tumors may mimic infectious abscesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation<\/jats:title>\n                    <jats:p>\n                      A 63\u2010year\u2010old Italian man presented with a 2\u2010week history of fever and right upper quadrant pain. Computed tomography revealed a multiloculated lesion with irregular margins and a solid component in the right hepatic lobe, suggestive of a liver abscess, and empirical tigecycline therapy was initiated. Low\u2010titer\n                      <jats:italic>Entamoeba<\/jats:italic>\n                      spp. IgG antibodies were detected, and percutaneous aspiration yielded material initially mischaracterized as \u201canchovy paste,\u201d raising suspicion for amoebic liver abscess. However, the patient failed to improve despite appropriate antiprotozoal therapy. Subsequent percutaneous drainage led to cavity resolution and symptom relief; all microbiological and parasitological tests were negative, and repeat\n                      <jats:italic>Entamoeba<\/jats:italic>\n                      serology became negative. Concurrent biopsy of the solid component revealed well\u2010differentiated pseudoglandular HCC. Magnetic resonance imaging demonstrated a biliary fistula associated with the neoplastic lesion, supporting a diagnosis of PLA secondary to HCC. The patient underwent right hepatectomy, complicated by intraoperative abscess rupture and postoperative intra\u2010abdominal abscesses caused by vancomycin\u2010resistant\n                      <jats:italic>Enterococcus faecium<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>PLA presenting as the initial manifestation of HCC is associated with poor prognosis, largely due to diagnostic delays. Limited clinical experience outside high\u2010prevalence regions and nonspecific clinical, laboratory, and imaging findings contribute to underrecognition of malignancy. Positive microbiological or serological results and transient clinical improvement during antimicrobial therapy do not exclude an underlying neoplasm. Liver biopsy and close radiologic follow\u2010up are essential in atypical or treatment\u2010refractory cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PLA as a presenting feature of HCC is unusual, especially in Europe, yet poses substantial diagnostic and therapeutic challenges. Increased clinical awareness and early histopathological evaluation are crucial to avoid delayed oncologic diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1155\/crhe\/9286315","type":"journal-article","created":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T07:35:31Z","timestamp":1787988931000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Abscess That Was Cancer: Pyogenic Liver Abscess as the Initial Manifestation of Hepatocellular Carcinoma in a Noncirrhotic Patient"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-7853-9360","authenticated-orcid":false,"given":"Francesco","family":"Siviero","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0926-5457","authenticated-orcid":false,"given":"Muhammad Ali","family":"Muslimani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6147-1920","authenticated-orcid":false,"given":"Sonia","family":"Lerta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5395-3966","authenticated-orcid":false,"given":"Sofia","family":"Frattola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3425-9817","authenticated-orcid":false,"given":"Pietro","family":"Valsecchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6695-4742","authenticated-orcid":false,"given":"Raffaella","family":"Lissandrin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5075-5626","authenticated-orcid":false,"given":"Laura","family":"Maiocchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Maestri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2976-7032","authenticated-orcid":false,"given":"Alessandro","family":"Vanoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2307-1544","authenticated-orcid":false,"given":"Angela Maria","family":"Di Matteo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0235-9207","authenticated-orcid":false,"given":"Raffaele","family":"Bruno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8437-6627","authenticated-orcid":false,"given":"Enrico","family":"Brunetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"e_1_2_13_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1607-551X(09)70546-7"},{"key":"e_1_2_13_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19881001)62"},{"key":"e_1_2_13_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0891-5520(05)70120-3"},{"key":"e_1_2_13_4_2","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v17.i2.103325"},{"key":"e_1_2_13_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2025.106574"},{"key":"e_1_2_13_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12879-024-09226-y"},{"key":"e_1_2_13_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2011.08.012"},{"key":"e_1_2_13_8_2","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840130414"},{"key":"e_1_2_13_9_2","doi-asserted-by":"publisher","DOI":"10.1086\/520290"},{"key":"e_1_2_13_10_2","first-page":"547","article-title":"Pyogenic Liver Abscess as the First Manifestation of Hepatobiliary Malignancy","volume":"8","author":"Chong V. 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