Complicated Isolated Liver Abscess Caused by Viridans Group Streptococci Leading to Right Hepatectomy.

Muhammad F Ahmed,Zainab Abbasi,Sajan Das,Alok Aggarwal,Sonu Sahni

doi:10.7759/cureus.9149

Abstract

Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are most often seen in developing countries and are less common in North America. The predominant etiology is infection occurring in the setting of direct extension of hepatobiliary or intestinal infection. The most common pathogen isolated from a PLA in the United States is Escherichia coli, whereas Streptococcus viridans is a rare entity in the developed world. Herein we report a rare case of a complicated isolated PLA in a patient without any known comorbidities which lead to hepatectomy. The patient was born and raised in the United States with no recent travel history. The patient was found to have 10 cm isolated multicystic mass on imaging confirmed later as vancomycin-resistant Streptococcus viridans PLA. The patient was treated with multiple intravenous antibiotics and underwent multiple ultrasound-guided percutaneous abscess drainages by interventional radiology, but all unsuccessful. The patient underwent right posterior liver lobectomy, thereafter making a quick recovery and was discharged. Our case underlines the significance of considering liver abscess as a differential even in previously healthy individuals with no known prior comorbid conditions, as prompt recognition is imperative in preventing morbidity and mortality.

Highlights

Viridans group streptococci (VGS) are a large group of commensal bacteria, most commonly a part of human oral flora and live in close association with the gingiva and the teeth
The most common pathogen isolated from a Pyogenic liver abscesses (PLAs) in the United States is Escherichia coli, whereas Streptococcus viridans is a rare entity in the developed world
Our case underlines the significance of considering liver abscess as a differential even in previously healthy individuals with no known prior comorbid conditions, as prompt recognition is imperative in preventing morbidity and mortality

Summary

Introduction

Viridans group streptococci (VGS) are a large group of commensal bacteria, most commonly a part of human oral flora and live in close association with the gingiva and the teeth These catalase-negative gram-positive organisms are further divided into five groups: Streptococcus mitis group, Streptococcus anginosus group, Streptococcus bovis group, Streptococcus mutans group, and Streptococcus salivarius group [1]. The patient stated that the pain had become excruciating rated 10/10 in severity which he described as dull in nature, non-radiating with no aggravating or relieving factors He complained of associated right-sided chest and flank pain. White Blood Cell Count Red Blood Cell Count Hemoglobin Hematocrit Mean Corpuscular Volume Platelet Count Neutrophils Absolute Lymphocytes Absolute Monocytes Absolute Eosinophils Absolute Basophils Absolute Prothrombin Time International Normalized Ratio Partial Thromboplastin Time Glucose Blood Urea Nitrogen Creatinine Sodium Potassium Chloride Bicarbonate Calcium Anion Gap Protein, Total Albumin Bilirubin, Total Bilirubin, Direct Alanine Transaminase Aspartate Transaminase Alkaline Phosphatase

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Disclosures

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