Multiple liver abscesses with isolation of Streptococcus intermedius related to a pyogenic dental infection in an immuno-competent patient

Abstract

Introduction: Streptococcus intermedius - a member of the Streptococcus anginosus group - is part of the normal microbial flora of the oral cavity. Despite being regarded as a harmless apathogenic commensal, Streptococcus intermedius has been described to cause abscesses in various locations of the body.

Case presentation: We report the clinical case and course of treatment of a 18-year-old male patient presenting with multiple hepatic abscesses associated with an untreated pyogenic dental infection.

Conclusion: Streptococcus intermedius can cause liver abscesses emerging from dental infectious foci even in previously healthy patients without underlying innate or aquired immunodeficiency. The case illustrates the potential danger and underestimated risk associated with untreated dental infections.

Figure 1

Pyogenic infection of molare 36, showing an open root canal on x-ray.

Figure 2

(left: 1-4): location of the 3 abscesses (A1, A2, A3) eligible for percutaneous drainage: abscess 1 (A1) already drained by the sonographically inserted catheter 1 (C1). Still undrained abscess A3. [note the right sided pleural effusion]; (right: 5-8): CT-guided insertion of catheter C2 in abscess A2.

Figure 3

Drainages in situ.

Figure 4

Clinical course of laboratory parameters and interventions (Note: the central venous catheter was already in place on referral of the patient).

Figure 5

A: Sonography on admission, B: Contrast media sonography on day 5 after admission, C: Sonographical follow-up 10 days after discharge.