An Unusual Case of Pyogenic Liver Abscess Secondary to Achromobacter xylosoxidans

Abstract

Achromobacter xylosoxidans is a catalase-positive, oxidase-positive, motile, gram-negative rod. When isolated, it is usually a cause of bacteremia in immunocompromised patients. Here we present a case of liver abscess caused by this rare organism in an immunocompetent host. A 57-year-old Colombian woman came to the emergency department with complaints of subacute onset of back pain, burning in urination, fever, nausea, and vomiting. She was febrile and tachycardic. Urinalysis was positive for leukocyte esterase, nitrite, and bacteria. The patient was started on empiric piperacillin tazobactam 3375 mg as intravenous piggyback every 8 hours. On day 3 of hospitalization, the patient continued to experience flank pain without improvement. Computed tomographic scan of the abdomen and pelvis with contrast revealed 2 thick-walled complex collections in the right hepatic lobe and the caudate lobe of the liver. Purulent aspirate grew A. xylosoxidans. In this report, we explore the characteristics of A. xylosoxidans and the associated infections it is known to cause as well as suggested treatments from previously reported cases.