Abstract
A hepatic abscess is a rare disease, especially in developed countries, and usually results from microbial contamination of liver parenchyma via an arterial or portal system or from a direct spread by contiguity. Pyogenic liver abscesses (PLA) are polymicrobial with Staphylococcus aureus accounting for less than 10% of the cases and methicillin-resistant Staphylococcus aureus (MRSA) accounting for even fewer. Colonic and hepatobiliary pathologies are often associated with reported MRSA abscesses. We report a case of MRSA bacteremia and liver abscess in an immunocompetent patient with no significant risk factors. Our patient presented with fever and abdominal pain of four days' duration. Laboratory studies revealed neutrophilic leukocytosis, elevated creatinine, c-reactive protein, and transaminitis. Blood culture was positive for MRSA. Computed tomography (CT) of the abdomen showed multiple areas of hypodensities over the left hepatic lobe that placed malignancy and abscess into the main differentials. A liver biopsy was consistent with liver abscess. Drainage was performed after a month of treatment with intravenous (IV) daptomycin and microbial analysis of the abscess was negative. Our case signifies the association of liver abscess and MRSA bacteremia in a patient with no significant risk factors and highlights the importance of prompt antibiotic treatment as first-line therapy.
Highlights
Liver abscesses can have bacterial, fungal, or amoebic organisms as an etiology
Pyogenic liver abscesses (PLA) are polymicrobial with Staphylococcus aureus accounting for less than 10% of the cases and methicillin-resistant Staphylococcus aureus (MRSA) accounting for even fewer
We report a case of MRSA bacteremia and liver abscess in an immunocompetent patient with no significant risk factors
Summary
Liver abscesses can have bacterial, fungal, or amoebic organisms as an etiology. Incidentally, amoebic and fungal abscesses occur predominantly in developing countries, mainly in Southeast Asia and Africa. We report the case of a liver abscess in an immunocompetent adult with community-acquired MRSA bacteremia that responded appropriately to systemic antibiotics before drainage, despite the large size of the abscess. A 73-year-old male with a past medical history significant for hyperlipidemia and atrial fibrillation with pacemaker implantation presented to the hospital with fever, abdominal pain, nausea, and decreased oral intake of four days' duration. Analysis from the hepatic abscess, including gram stain, routine bacterial, and amoebic serology, was negative The source of his liver abscess was believed to be from MRSA bacteremia that was effectively treated with daptomycin before the abscess drainage which led to the negative bacterial culture of the liver abscess analysis
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