Pyogenic Liver Abscess with No Predisposing Risk Factors

Abstract

Pyogenic liver abscesses (PLA) are an uncommon cause of hospitalization in the United States. The majority of such cases are polymicrobial and are most commonly caused by seeding of infection from the biliary system. PLA is frequently associated with specific comorbidities such as diabetes mellitus, history of liver transplant, underlying hepatobiliary, or pancreatic disease. Herein, we describe a 47-year-old healthy male with no known risk factors associated with PLA who presented to the hospital with acute fever, abdominal pain, and dark colored urine. Initially the patient had a negative right upper quadrant ultrasound. However, the patient continued to have persistent fevers and abnormal liver biochemistries with negative liver serology that led to checking a magnetic resonance cholangiopancreatography which suggested multiple liver abscesses. Computer tomography guided aspiration revealed a monobacterial Streptococcus species within the abscess, which is commonly associated with arterial bacteremia as a source of PLA. Arterial bacteremia is one of most rare causes of PLA. The patient's septic workup was negative for any source of infection. This case demonstrates a patient with no risk factors who was diagnosed with PLA caused by apparent arterial bacteremia with no clear source of infection.

Pyogenic liver abscess: Clinical features and microbiological profiles in tertiary care center

“…Our study is in coherence with some studies. [ 3 9 ] But, this is in contrast to several studies which found a mean age in sixth and seventh decades. [ 4 10 11 12 13 ] Most of the studies found both male and female as patients and male outnumbered over female.…”

“…PLA accounts for 48% of visceral abscess. [ 9 ] It has still a great impact on health care facility and delay or improper management may lead to significant loss of life. In our study, the mean age of patients was 37.9 years with maximum cases (44%) between 31 and 40 years age group.…”

“…There are many predisposing factors for PLA such as biliary tract disease, portal pyemia, malignancy, or contiguous spread of infection from intraabdominal organs. [ 3 9 ] Biliary tract diseases account for 50%–60% of all cases. [ 9 ] But, newer studies suggest that there is an increasing trend of cryptogenic PLA.…”

“…[ 3 9 ] Biliary tract diseases account for 50%–60% of all cases. [ 9 ] But, newer studies suggest that there is an increasing trend of cryptogenic PLA. [ 3 20 21 22 ] All twenty-five cases (100%) in our study were cryptogenic in nature which was in confirmation with these studies.…”

How to manage: liver abscess

“…Its incidence varies between 2.3 and 17.59 per 100 000 inhabitants per year,1–3 and in hospitalised patients, it is 8–22 cases per 100 000 hospital admissions 4. Usually occurs in Caucasian men between 50 and 60 years old 5.…”