Exceptional source of liver abscess: 3 cases of oropharynx origin

Abstract

Background: Pyogenic liver abscess is a rare entity, it is fatal when untreated. Its approach has been improved due to percutaneous drainage and better microbiological characterization. In our environment, the most common pathogens are Enterobacteriaceae. Our aim is to present 3 cases of liver abscess caused by unusual microorganisms, habitual commensals of the oropharynx. Material & Methods: Two men and a women was admitted to emergency service with a story of fever (>38.5ºC). Case 1: A 64-year-old man without other sintoms. US and CT scan was performed, showed focal subcapsular lesion in the VII-VI segment, hypoechoic with hyperechogenic areas suggestive of abscess. Abscess drainage was performed and positive culture was obtained for Haemophilus parainfluenzae. Case 2: A 57-year-old woman mujer de 57 with jaundice and coluria. CT scan reported multiple hepatic abscesses. Abscess drainage was performed with positive culture for Streptococcus intermedium. The orthopantomography study showed radicular remnants of 36 and 46, both with implants. Case 3: A 61-year-old man with abdominal pain. CT showed heterogeneous mass in liver segments VII and VIII with small cystic areas inside. Abscess drainage was performed with positive culture for Streptococcus intermedium. Orthopantomography showed septic foci associated with implants. Results: All three patients were admitted with antibiotic treatment and radiologic drainage. In two of them (cases 1 and 3) antibiotic treatment was not enough, therefore surgery was performed; while in case 2 the antibiotic treatment was adequate. In addition, cases 2 and 3 received surgical treatment by maxillofacial surgery to extract the dental pieces. Currently, patients are asymptomatic. Conclusions: Haemophilus parainfluenzae and Streptococcus intermedium are a uncommon cause of liver abscess. Without treatment, the mortality of the liver abscess is 100%. Early diagnosis and correctly isolate the pathogens are essential even more when we face something uncommon.