Pyogenic liver abscesses caused by Streptococcus mitis are rare with only three cases having been reported in the literature in the last three decades. We report two cases of liver abscesses caused by Streptococcus mitis that presented to Winthrop University Hospital in the past year. The first case involved a 40-year-old male who presented with intermittent fevers and abdominal pain approximately one month after being treated for a strep throat infection. Abdominal ultrasonography identified a right hepatic lobe abscess of 5.4 x 5.1 x 4.9 centimeters. Laboratory tests revealed elevated AST 69 IU/L, ALT 102 IU/L, and Alkaline Phosphatase 358 IU/L levels. Culture of the abscess fluid was positive for Streptococcus mitis. The second case was a 34-year-old male who presented with persistent chills, cyclic vomiting, and abdominal pain. He was found on abdominal ultrasound to have two right hepatic lobe abscesses of 11.2 x 7.2 x 9.4 and 8.3 x 6.0 x 6.1 centimeters. Laboratory tests revealed elevated AST 417 IU/L, ALT 412 IU/L, Alkaline Phosphatase 255 IU/L, Total Bilirubin 5.1 mg/dL and Direct Bilirubin 3.4 mg/dL levels. Blood and abscess cultures grew Streptococcus mitis. A transesophageal echocardiogram (TEE) showed new onset cardiomyopathy. Prior cases of Streptococcus mitis liver abscesses published in the literature include a patient with chronic gingivitis and history of streptococcal liver abscess, a patient with pyridoxal-dependent Streptococcus mitis, and a patient who presented with fever and non-bloody diarrhea. In each of these cases the mechanism of spread was not well established. Recent dental work, poor oral hygiene, endoscopic interventions, gastric malignancy, and Lemierre's disease have all been shown to lead to the development of liver abscesses from viridans group streptococci. However, not all patients with liver abscesses have these inciting factors, as these case examples demonstrate. Hence, a high index of suspicion, along with computed tomography imaging (CT) and broad-spectrum antibiotics, is required to diagnose and appropriately manage liver abscesses. These two cases highlight the need to further investigate the incidence and possible mechanisms of spread of Streptococcus mitis to the liver.Figure: Case #1 Right Hepatic Lobe Abscess.Figure: Case #2 Right Hepatic Lobe Abscesses.Table. Cases