{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T15:20:32Z","timestamp":1778167232958,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Healthcare"],"abstract":"<jats:p>Background: Management of giant pyogenic liver abscesses (PLA) remains challenging, particularly in culture-negative cases, where clinical improvement may not reflect adequate local disease control. Case Description: A 65-year-old woman with well-controlled type 2 diabetes mellitus presented with several weeks of systemic symptoms, marked inflammatory response, cholestatic liver injury, and acute kidney dysfunction. Contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed a large, multiloculated hepatic lesion measuring approximately 10 cm, consistent with a giant PLA. Empirical broad-spectrum antimicrobial therapy resulted in rapid clinical and biochemical improvement; however, follow-up imaging demonstrated further enlargement of the abscess. Microbiological cultures from blood, urine, and the abscess cavity remained negative. In view of radiological progression, CT-guided percutaneous catheter drainage was performed, resulting in effective evacuation and subsequent lesion regression. Long-term follow-up confirmed complete resolution without recurrence. Conclusions: This case highlights that clinical and laboratory improvement alone may be insufficient to assess treatment response in giant, culture-negative PLA. Serial imaging plays a key role in identifying inadequate local disease control and guiding timely escalation to image-guided intervention.<\/jats:p>","DOI":"10.3390\/healthcare14101262","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T14:05:46Z","timestamp":1778162746000},"page":"1262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["When Clinical Improvement Does Not Reflect Radiological Response: A Culture-Negative Giant Pyogenic Liver Abscess"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1060-314X","authenticated-orcid":false,"given":"Zuzanna","family":"\u017bak-Skry\u015bkiewicz","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, 02-091 Warsaw, Poland"},{"name":"Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Br\u00f3dnowski Hospital, Kondratowicza 8, 03-242 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justyna","family":"Nowak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Br\u00f3dnowski Hospital, Kondratowicza 8, 03-242 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomasz","family":"Oleksiuk","sequence":"additional","affiliation":[{"name":"Department of Radiology, Mazovian Br\u00f3dnowski Hospital, Kondratowicza 8, 03-242 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Przemys\u0142aw","family":"Witek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Endocrinology and Diabetes, Medical University of Warsaw, 02-091 Warsaw, Poland"},{"name":"Department of Internal Medicine, Endocrinology and Diabetes, Mazovian Br\u00f3dnowski Hospital, Kondratowicza 8, 03-242 Warsaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1002\/ueg2.12132","article-title":"Epidemiology of pyogenic liver abscesses in Germany: Analysis of incidence, risk factors and mortality rate based on routine data from statutory health insurance","volume":"9","author":"Zimmermann","year":"2021","journal-title":"United Eur. 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