title: Pyogenic liver abscess caused by Fusobacterium in a 21-year-old immunocompetent male.
abstract: A 21-year-old male with no significant past medical history, presented with right upper quadrant (RUQ) abdominal pain along with fevers and chills. Lab work revealed leukocytosis, anemia, and slightly elevated alkaline phosphatase. Viral serology for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus were negative and he was immunocompetent. Computed tomography imaging revealed hepatic abscesses, the largest measuring 9.5 cm. Empiric antibiotics were started and percutaneous drains were placed in the abscesses. Anaerobic cultures from the abscesses grew Fusobacterium nucleatum. This is a gram negative anaerobic bacteria; a normal flora of the oral cavity. Fusobacterium is most commonly seen in Lemiere's disease, which is translocation of oral bacteria to the internal jugular vein causing a thrombophlebitis and subsequent spread of abscesses. Our patient did not have Lemiere's, and is the first case described of fusobacterium pyogenic liver abscess in a young immunocompetent male with good oral hygiene. This case was complicated by sepsis, empyema, and subsequent abscesses located outside the liver. These abscesses' have the propensity to flare abruptly and can be fatal. This case not only illustrates fusobacterium as a rare entity for pyogenic liver abscess, but also the need for urgent diagnosis and treatment. It is incumbent on physicians to diagnose and drain any suspicious hepatic lesions. While uncommon, such infections may develop without any overt source and can progress rapidly. Prompt drainage with antibiotic therapy remains the cornerstone of therapy.
authors.affiliation: Zohair Ahmed, Saurabh Bansal, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States.
authors.forename: Zohair
authors.initials: Z
authors.lastname: Ahmed
authors.affiliation: Zohair Ahmed, Saurabh Bansal, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States.
authors.forename: Saurabh K
authors.initials: SK
authors.lastname: Bansal
authors.affiliation: Zohair Ahmed, Saurabh Bansal, Department of Internal Medicine, University of Illinois Peoria Campus, OSF Saint Francis Medical Center, Peoria, IL 61637, United States.
authors.forename: Sonu
authors.initials: S
authors.lastname: Dhillon
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004322:Drainage; D005674:Fusobacterium Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D016967:Fusobacterium nucleatum / Q000302:isolation & purification*; D006801:Humans; D007121:Immunocompetence; D046290:Liver Abscess, Pyogenic / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology* / Q000628:therapy; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Fusobacterium; Hepatic abscess; Immunocompetent; Liver; Pyogenic
references.citation: Gastroenterology. 2014 Jan;146(1):129-37.e1
references.pmid: 24095786
references.citation: Surg Clin North Am. 2010 Aug;90(4):679-97
references.pmid: 20637941
references.citation: J Microbiol Immunol Infect. 2002 Mar;35(1):65-7
references.pmid: 11950124
references.citation: J Gastroenterol Hepatol. 2002 Sep;17(9):1001-7
references.pmid: 12167122
references.citation: Clin Infect Dis. 2002 Sep 1;35(Suppl 1):S22-7
references.pmid: 12173104
references.citation: N Engl J Med. 2003 Apr 17;348(16):1565-73
references.pmid: 12700377
references.citation: Curr Gastroenterol Rep. 2004 Aug;6(4):273-9
references.pmid: 15245694
references.citation: J Clin Gastroenterol. 1987 Apr;9(2):194-7
references.pmid: 2952706
references.citation: J Infect. 1992 May;24(3):321-5
references.pmid: 1602152
references.citation: Am J Gastroenterol. 1992 Dec;87(12):1740-3
references.pmid: 1449134
references.citation: J Infect. 1994 Mar;28(2):155-65
references.pmid: 8034995
references.citation: Clin Microbiol Rev. 1996 Jan;9(1):55-71
references.pmid: 8665477
references.citation: Antimicrob Agents Chemother. 1999 May;43(5):1270-3
references.pmid: 10223950
references.citation: Clin Infect Dis. 2007 May 1;44(9):1194-201
references.pmid: 17407038
references.citation: Korean J Gastroenterol. 2011 Jan;57(1):42-6
references.pmid: 21258201
references.citation: World J Gastroenterol. 2011 Mar 28;17(12):1622-30
references.pmid: 21472130
references.citation: Diagn Microbiol Infect Dis. 2011 Jun;70(2):167-74
references.pmid: 21596220
references.citation: J Gastroenterol Hepatol. 2012 Feb;27(2):248-55
references.pmid: 21777280
references.citation: World J Gastroenterol. 2012 Jun 21;18(23):2948-55
references.pmid: 22736918
references.citation: Aliment Pharmacol Ther. 2012 Sep;36(5):467-76
references.pmid: 22779737
references.citation: Colorectal Dis. 2012 Dec;14(12):e794-801
references.pmid: 22776247
references.citation: Clin Res Hepatol Gastroenterol. 2013 Feb;37(1):86-92
references.pmid: 22572520
references.citation: Diagn Microbiol Infect Dis. 2013 Dec;77(4):373-5
references.pmid: 24094834
references.citation: Intern Med. 2008;47(7):675-8
references.pmid: 18379160
references.citation: J Microbiol Immunol Infect. 2009 Aug;42(4):336-42
references.pmid: 19949758
references.citation: Am J Gastroenterol. 2010 Jan;105(1):117-24
references.pmid: 19888200
references.citation: J Microbiol Immunol Infect. 2009 Oct;42(5):385-92
references.pmid: 20182667
references.citation: BMC Infect Dis. 2013;13:264
references.pmid: 23734900