Asymptomatic Incidental Pyogenic Hepatic Abscess in an Obese Adult

Abstract

A 35-year-old obese female patient presented to the emergency department (ED) endorsing symptoms of generalized weakness, dyspnea, and myalgia. Vitals on admission revealed hypotension, tachycardia, and a low-grade fever. Physical examination was unremarkable and was negative for any upper right quadrant tenderness or jaundice. Laboratory results revealed an elevated leukocytosis with a predominantly elevated neutrophil count, an elevated lactate dehydrogenase, aminotransferases, and an elevated anion gap. Sepsis protocol was initiated. Blood cultures revealed Group F Streptococcus. A chest x-ray for localization of the primary infection source was significant for an incidental hypodense liver mass. A follow-up magnetic resonance imaging (MRI) without contrast revealed a left hepatic multiloculated enhancing lesion prompting the diagnosis of beta-hemolytic Group F Streptococcus pyogenic hepatic abscess (PHA). This unusual case seeks to inform that an obese patient (i.e., immunocompromised) with systemic signs (e.g., fever, hypotension, tachycardia) should warrant careful monitoring as well as the inclusion of pyogenic liver abscess in the differential workup as our patient's PHA was found incidentally on a chest x-ray. Appropriate management via sonographic guided drainage was initiated and systemic antibiotics were administered in both inpatient and outpatient settings, resulting in complete resolution of the hepatic abscess over the course of a month.

Keywords: group f streptococcus; incidental hepatic abscess; obese patient; pyogenic hepatic abscess; streptococcus constellatus.

Figure 1. T-1 MRI abdomen with an annotated hepatic abscess in the lower left lobe

Figure 2. CT abdomen with resolving hepatic abscess in the left lower lobe