A Unique Case of Multiple Hepatic Abscesses Secondary to Haemophilus parainfluenzae and Streptococcus intermedius

Abstract

Introduction: Hepatic abscesses (HA) are fairly rare in the United States, however they are extremely fatal. HAs are most commonly associated with biliary disease, inflammatory bowel disease, diverticulitis, gastrointestinal malignancy, diabetes, and immunodeficiency. Escherichia coli is the most commonly implicated bacteria in the development of HAs. Herein, we report a rare case of multiple hepatic abscesses secondary to bacteria of the oropharyngeal flora, Streptococcus intermedius and Haemophilus parainfluenzae. Case Report: A 37-year-old man presented to the emergency department with progressively worsening epigastric pain and fever up to 103.0 °F for three days. Other symptoms included intermittent chills, nausea and vomiting, and intermittent abdominal pain coupled with constipation for a period of one month. Past history was significant for a tooth extraction due to cavity infection 1.5 months prior to admission. Physical examination revealed hepatomegaly and exquisite tenderness to light palpation of the right upper quadrant of the abdomen. Computed tomography (CT) scan with IV contrast of his abdomen showed diffuse areas of multifocal hypoattenuation throughout the liver without any significant enhancement. An accumulation of fluid in the cavities, consistent with liver abscesses was also noted. Drainage of the abscesses by CT-guided fine needle aspiration (FNA) was performed. FNA and blood cultures grew H. parainfluenzae and S. intermedius. He was treated with metronidazole and piperacillin/tazobactam for 1 week followed by a course of metronidazole and ampicillin/sulbactam for 2 weeks. Conclusion: Hepatic Abscess secondary to Haemophilus parainfluenzae and Streptococcus intermedius are a unique manifestation and must be considered in patients receiving dental treatment.