3194 Sneaky Abscess-Ion: A Pyogenic Liver Abscess Masquerading as the Flu

Abstract

INTRODUCTION: Pyogenic liver abscess (PLA) is due to leakage of intra-abdominal contents with hepatic spread via the portal circulation. The incidence of PLA is estimated to be 2.3 cases per 100,000 people with higher rates among men than women [1]. We present a case of a 58-year-old male with no abdominal tenderness, risk factors, or recent travel history, who was found to have a 3 cm liver abscess growing Klebsiella Pneumoniae (K.pneumoniae). CASE DESCRIPTION/METHODS: The patient is a 58-year-old African American man with a medical history of HTN and HLD who presented with 3-day history of muscle aches, subjective fevers, and chills. Initially the patient was suspected to have a flu and was treated with fluids and antipyretics. He was noted to have transaminitis (AST/ALT: 202/139), however denied nausea or abdominal pain. An ultrasound demonstrated a complex cystic mass in the right lobe of the liver, and a CT Abd/Pelvis showed a 3.2 × 3.1 × 2.3 cm heterogeneous hypodense mass in segment V. The patient remained febrile with a Tmax of 102 and began to develop severe RUQ on day two of admission. The patient was maintained on Zosyn 3.375g q6h and initial blood cultures grew gram negative rods. Patient tolerated IR drainage of liver abscess yielding 10cc pustular fluid with subsequent resolution of fever. Both blood and liver cultures grew pan-sensitive K.pneumoniae. DISCUSSION: PLA commonly develops as a complication of biliary tract disease in 40% of cases [2]. In the United States, K. pneumoniae is the predominant pathogen causing PLA; isolated in greater than 60% of monomicrobial and polymicrobial PLA [3]. Groups who are susceptible to infection with K. pneumoniae include patients of Asian ethnicity, diabetics, and those with antibiotic use [2]. Our patient did not have any risk factors for PLA; he had minimal medical history and only took amlodipine on presentation. Common symptoms of PLA include fever, right upper quadrant abdominal pain, and rarely jaundice [1]. Our patients' initial presentation was consistent with a flu like prodrome; however, his transaminitis suggested an underlying hepatic process. While a PLA was unlikely on admission, worsening sepsis and new abdominal pain elucidated the diagnosis. K. pneumoniae PLA can lead to disseminated infections including meningitis; the identification and drainage of an abscess early in the hospital course can alter a patients' mortality. While PLA is rare, it should still remain on the differential diagnosis for septic patients.