We report the case of a 61-year-old woman with cryptogenic liver absce
sses who had been profoundly ill with severe upper abdominal pain, imp
aired consciousness, prostration, continuous high fever secondary to s
epsis, and thrombocytopenia (platelets, 1-5 x 10(4)/mm(3)) since admis
sion. Ultrasonograms and computed tomograms revealed two separate mult
iloculated lesions in the right lobe of the liver, consistent with the
liver abscesses. Immediately after diagnosis, percutaneous abscess dr
ainage was performed under ultrasonographic guidance; however, only a
small amount of pus was drained, prompting continuous irrigation of th
e abscess cavity. Four days later, transcatheter hepatic arterial infu
sion of antibiotics was attempted. However, the abscesses had enlarged
and her general condition had worsened. On hospital day 8, she underw
ent right hepatectomy because the multiloculated lesions were refracto
ry to drainage. The operation was successful in terms of hepatectomy,
although she continued to suffer from sepsis, secondary right subphren
ic abscess formation, and prolonged thrombocytopenia with associated c
oagulation disorders for two months. Examination of multiple cross sec
tions of the resected specimen disclosed that the lesions consisted of
aggregations of multiple small locules. There was no communication be
tween the locules and there were true septations, rather than multiloc
ulated lesions with pseudoseptations. The patient has been well for 2
years without recurrent abscess of the liver or any infectious disease
.