<i>Lactobacillus acidophilus</i> as a Cause of Liver Abscess in a NOD2/CARD15-Positive Patient with Crohn’s Disease

Abstract

Introduction: The development of a fistula and/or an abscess are major complications in patients with Crohn’s disease. An abscess can involve any of the major viscera, including the liver and spleen. Case Report: A 27-year-old male patient with a 6-month history of NOD2/CARD15-positive Crohn’s disease with stenosis of the terminal ileum, previously treated with corticosteroids, was admitted with fever, chills, diarrhea, fatigue and cachexia. Diagnostic work-up revealed sepsis, an abscess in the right hepatic lobe, multiple abdominal collections and right-sided pleural effusion. It was felt that his poor general condition prevented surgical intervention and complex conservative treatment was initiated. It consisted of total parenteral nutrition, antibiotics, percutaneous drainage of the liver abscess, and thoracocentesis. Pus and blood cultures showed Lactobacillus acidophilus. There was a gradual improvement in the patient’s condition and the liver abscess decreased in diameter from 14 to 2 cm. Aminosalicylates and enteral nutrition were gradually introduced. The patient was discharged after 9 weeks in good general condition. Conclusion: Although extremely rarely, L. acidophilus can cause hepatic abscess and sepsis. This can be explained by immunologic incompetence due to corticosteroid treatment of Crohn’s disease.

Nutrigenomics in the whole-genome scanning era: Crohn’s disease as example

“…Although probiotic therapy was considered to show promise for some individuals with CD, clinical trials suggest that those tested to date have limited efficacy, except for cases of pouchitis [74]. While probiotics may sometimes be beneficial for CD patients, it should be noted that Cukovic-Cavka et al [75] attributed liver abscess in a CARD15-positive patient with CD to Lactobacillus acidophilus. In this example, they suggested the cause may have been immunologic incompetence due to corticosteroid treatment of CD.…”

Safety Assessment of Lactobacillus salivarius REN, a Probiotic Strain Isolated from Centenarian Feces

“…However, the safety of probiotic bacteria has also raised concern due to some causative pathogenic cases. Some probiotics are reported to be associated with clinical diseases such as sepsis (Salminen et al, 2004), endocarditis (Aguirre and Collins, 1993), liver abscesses (Cukovic-Cavka et al, 2006), and urinary tract infections (Aznar et al, 2004). Probiotics are widely used in food throughout the world because of their beneficial effects, thus safety issues and side effects should be considered before their application (Abe et al, 2010).…”

Crohnʼs disease and liver abscess due to Pediococcus sp.

“…The presence of other germs of the family Lactobacillaceae is equally exceptional, with seven published cases and only one in CD. 2,3 The association between CD and liver abscess is uncommon, most authors considering them to originate through a hematogenous route when an increase in mucosal permeability exists toward the portal system, 4,5 even though it may sometimes be secondary to acute cholangitis caused by biliary pathology associated with inflammatory bowel disease (IBD) or by enterobiliary fistulae. 6,7 This is reported generally in males, of younger age than in the general population (biliary origin), with long-term and active CD-although it has been reported an early stage.…”