Pyogenic liver abscess: Where did it come from, how did it grow?

Document Type

Conference Proceeding

Publication Date


Publication Title

Am J Gastroenterol


Introduction: Liver abscesses are suppurative space occupying lesions resulting from the invasion of the liver tissue by insult/injury, intraabdominal infection disseminated from the portal venous circulation, or originate in the biliary system. Three different etiologies consist of pyogenic, amebic and fungal abscesses. The common cause of liver abscess in the United States is bacterial intraabdominal source. Additionally, the right lobe of liver is mostly an affected region as it's predominately supplied by superior mesenteric vein. We describe an unusual case of right hepatic lobe abscess with unidentifiable source. Case Description/Methods: We present a 79-year-old woman with a medical history of diabetes and hypertension who presented with complaint of fatigue. She otherwise denied recent illness, travel, hospitalizations or intestinal infections. On presentation, she was hypotensive and admission labs significant for neutrophil predominant leukocytosis. The patient exhibited right upper quadrant tenderness. Blood cultures were obtained. Broad spectrum antibiotics were started. Pertinent imaging revealed a hepatic mass measuring 8.9 x 8.3 x 7.1 cm in the right lower lobe of liver. Interventional radiology performed a biopsy and aspiration of 60 mL purulent fluid. Blood cultures grew Bacteriodes fragilis. Surgical liver pathology was predominately fragments of necrotic hepatic tissue with acute inflammation. Liver abscess cultures speciated Escherichia coli, Klebsiella pneumonia, and Streptococcus intermedius. Antibiotics were tailored accordingly. This prompted an echocardiogram which was negative for valvular vegetations. The patient opted for outpatient colonoscopy for further evaluation. Repeat liver imaging showed enlarging abscess, therefore drain was placed. Patient was sent home on 6 week course of antibiotics. Discussion: While the incidence of liver abscess is low, it is essential to have a complete understanding of the disease activity and harm potential because the severity of these abscesses have a high mortality if left untreated. The physiology of disease is so delicate in these patients that an abscess located in the liver parenchyma close to the diaphragm can cause referred pain to the right shoulder or potentially a cough caused by diaphragmatic irritation. Although imaging was negative for etiology of the abscess, the workup is still in progress. This case highlights the importance of antibiotic therapy with drain placement to achieve source control and clinical and bacteriologic cure.

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Not assigned.





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