Community-Acquired Methicillin-Resistant Pyogenic Liver Abscess: A Case Report.

Joel Cherian,Chiranjay Mukhopadhyay,Muralidhar Varma,Rahul Singh,Sudha Vidyasagar

doi:10.1177/2324709616660576

Joel Cherian, Chiranjay Mukhopadhyay + Show 3 more

Open Access

https://doi.org/10.1177/2324709616660576

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Abstract

Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatobiliary causes (40% to 60%). Most are polymicrobial with less than 10% being caused by Staphylococcus aureus. Of these, few are caused by methicillin-resistant Staphylococcus aureus (MRSA) and fewer still by a community-acquired strain. Here we present a case study of a patient with a community-acquired MRSA liver abscess. The patient presented with fever since 1 month and tender hepatomegaly. Blood tests revealed elevated levels of alkaline phosphatase, C-reactive protein, erythrocyte sedimentation rate, and neutrophilic leukocytosis. Blood cultures were sterile. Ultrasound of the abdomen showed multiple abscesses, from which pus was drained and MRSA isolated. Computed tomography of the abdomen did not show any source of infection, and an amebic serology was negative. The patient was started on vancomycin for 2 weeks, following which he became afebrile and was discharged on oral linezolid for 4 more weeks. Normally a liver abscess is treated empirically with ceftriaxone for pyogenic liver abscess and metronidazole for amebic liver abscess. However, if the patient has risk factors for a Staphylococcal infection, it is imperative that antibiotics covering gram-positive organisms be added while waiting for culture reports.

Highlights

Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and cause approximately 15 out of 100 000 hospital admissions.[1]
At least 13 cases of pyogenic liver abscesses caused by methicillin-resistant Staphylococcus aureus (MRSA) are reported in English literature, of which a minimum of 5 are community acquired
We assumed that the source of infection was the skin since he was previously treated for a skin infection with antibiotics

Summary

Introduction

Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and cause approximately 15 out of 100 000 hospital admissions.[1]. At least 13 cases of pyogenic liver abscesses caused by MRSA are reported in English literature, of which a minimum of 5 are community acquired. These reports suggest that pyogenic liver abscesses of MRSA origin may follow a aggressive course variability of severity was seen.

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