Acute Presentation of Simultaneous Liver Abscesses Caused by Streptococcus constellatus

Abstract

Simultaneous liver abscesses are rarely seen and reported. We are reporting a case of two simultaneous, complex liver abscesses in a patient who had no evidence of liver abscess on cross-sectional imaging close to three months prior to this presentation. These abscesses were 7-8 cm in size, large, and septated. Microbiological studies were positive for Streptococcus constellatus, which is a known cause of pyogenic liver abscess. In our patient, pyogenic liver abscesses were associated with bacteremia and sepsis. This patient was managed with broad spectrum parenteral antibiotics and percutaneous drainage with improvement in clinical condition. This patient was discharged home with a peripherally inserted central catheter (PICC) line in place to complete a six-week course of parenteral antibiotics. A complete history and physical with pertinent examination findings are key to diagnosis of liver abscess. S. constellatus should be considered in the differential diagnosis of patients with liver abscess and sepsis.

Keywords: drainage; liver abscess; streptococcus constellatus.

Figure 1. CT abdomen done in October 2019.

Depicting two large, multiloculated abscesses in right lobe of liver, measuring each 7-8 cm in size.

Figure 2. CT abdomen done in July 2019.

Depicting no liver mass or abscess seen.

Figure 3. CT abdomen/pelvis done in October 2019.

Depicting left pelvic collection possible sigmoid abscess/communication of colovesical fistula.

Figure 4. CT abdomen done in December 2019.

Depicting resolution of both liver abscesses after percutaneous drainage and six weeks of IV antibiotics.