S2463 A Rare Case Report of a Liver Abscess Secondary to Crohn’s Disease

Liver Abscess Secondary to Crohn’s Disease: A Case Report

“…The urinalysis was positive for small leukocyte esterase, trace bacteria and white blood cells (5-10/HPF). A Computerized Tomography (CT) scan of the abdomen and pelvis without contrast was performed, demonstrating multiple liver lesions highly suspicious of liver abscess with the differential diagnosis including metastasis (Figures 1A, 1B) [6]. The patient was admitted to the hospital for sepsis and was started on intravenous piperacillin-tazobactam 3.375 milligrams every eight hours and intravenous fluids.…”

“…A 45-year-old Hispanic male with a past medical history of Crohn's ileo-colitis with hemicolectomy, complicated by anal fistulas, presented with abdominal pain in the right upper quadrant, subjective fever of three weeks duration and a visible new peri-rectal fistula upon self-examination [ 6 ]. Review of systems was also significant for unintentional 10-pound weight loss over the course of five weeks and increased stool output from his ileostomy lasting a few weeks prior to admission [ 6 ]. The patient was compliant with infliximab and 6-mercaptopurine for CD and otherwise had good control over his inflammatory bowel disease (IBD).…”

“…The patient was compliant with infliximab and 6-mercaptopurine for CD and otherwise had good control over his inflammatory bowel disease (IBD). On admission the patient was febrile (38.4°C), hypotensive (106/72 mmHg), with a heart rate of 86 beats per minute, respiratory rate of 18 and saturation of 100% on room air [ 6 ]. He was well appearing, in no acute distress with an abdominal exam notable for moderate tenderness in the right upper quadrant upon superficial and deep palpation.…”

“…He was well appearing, in no acute distress with an abdominal exam notable for moderate tenderness in the right upper quadrant upon superficial and deep palpation. He was noted to have an ileostomy bag filled with normal brown stool and an external anorectal exam showed multiple fistulas draining sero-fibrinous fluid without odor [ 6 ]. The remainder of the exam was unremarkable.…”

“…These factors in conjunction with other factors such as fistula formation, long-term steroid use, as well as chronic malnutrition increase the risk of developing liver abscesses [ 5 ]. It is important for clinicians to consider liver abscess as a differential in a CD patient presenting with symptoms of fever and right upper quadrant, despite having adequate control over their disease [ 6 ].…”