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Program

Internal Medicine

Training Level

Resident PGY 1

Institution

Henry Ford Hospital

Abstract

Fusobacterium nucleatum is a facultative anaerobic gram-negative bacillus found in the oral cavity, gastrointestinal tract, and genitourinary tract. Fusobacterium nucleatum is a rare cause of hepatic abscesses and empyema. We describe a case of Fusobacterium liver abscess and empyema, resulting in extensive thrombophlebitis in intraabdominal and extremity veins. A 78-year-old female with past medical history significant for bicytopenia and tooth repair 8 months prior presented with mild diarrhea and fatigue. She was febrile, tachycardic, and tachypneic. On physical exam, she had mild epigastric tenderness and bilateral lower extremity pitting edema. Labs were notable for an AKI and elevated LFTs. Imaging revealed multiple >10cm hepatic abscesses, a small right pleural effusion, a segmental pulmonary embolism, along with extensive intraabdominal and extremity DVTs. Vascular surgery did not recommend intervention. She underwent IR drainage of three abscesses as well as chest tube drainage of pleural effusion. Blood, abscesses, and pleural effusion culture grew Fusobacterium nucleatum. Plural effusion also grew Lactobacillus rhamnosus. She received metronidazole and was eventually switched to ampicillin/sulbactam. Source and malignancy work up were negative. The source of Fusobacterium nucleatum hepatic abscesses in descending order of frequency is periodontal flora, cryptogenic, and gastrointestinal tract. Given her diarrhea, the source may have been translocation from her gastrointestinal tract, however, it could also be periodontal due to her recent tooth repair. Treatment includes source control and antibiotics, ranging from 2 weeks to 6 months. This case illustrates the rare disease process of Fusobacterium hepatic abscess formation and the bacteria’s thrombogenic characteristics.

Presentation Date

5-2020

Fusobacterium nucleatum: A Rare Presentation of Hepatic Abscesses

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