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

Streptococcus viridans Liver Abscess and Septicemia Likely Secondary to a Swallowed Dental Bridge

Pyogenic liver abscesses are relatively rare in developed countries such as the United States, and, when they do occur, they are typically secondary to direct or hematogenous spread of intra-abdominal pathologies. Gastrointestinal pathogens such as Escherichia coli and Enterococcus species are typically implicated. Conversely, the Streptococcus viridans group is a rare cause of bacteremia and abscess formation, especially in immunocompetent patients. We present a case of a 53-year-old male who presented with S. viridans liver abscess that was found to be secondary to a swallowed dental bridge that was lodged in the patient's descending colon. The patient was treated with intravenous antibiotics, percutaneous drainage, and colonoscopy for removal of the foreign body; the patient had a good response to treatment and was discharged on oral antibiotics. In any patient who has fever and abnormal liver function tests, hepatobiliary sepsis including liver abscess should always be excluded. Additionally, it is important to suspect unusual pathogens and sources of infection. We suggest empiric broad-spectrum antibiotic coverage when liver abscess is suspected and tailoring treatment as the specific organism and susceptibilities are identified. Moreover, we suggest the importance of removing any foreign bodies promptly upon discovery as they may serve as an important nidus of infection.

A Rare Case of Viridans Group Streptococci Pyogenic Liver Abscess in a Young Male With No Prior Risk Factors

Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are rare in North America and other developed countries. The predominant etiology of PLAs is an infection extending from the hepatobiliary or intestinal system. As such, the most common pathogens isolated from PLA in the United States are Escherichia coli and Klebsiella. Viridans group streptococci (VGS), on the other hand, are a large group of commensal bacteria in the oral flora and are a significantly less common cause of infection. Here, we report a rare case of a complicated isolated VGS PLA in a patient without known comorbidities. The patient was born and raised in the United States without recent travel history. Computed tomography (CT) with contrast showed multiple hypodense multiloculated lesions in the right lobe of the liver, measuring up to 13 cm, with mild wall thickening of the distal ileum and cecum. The abscesses were confirmed later as Streptococcus viridans PLA. The patient was treated with CT-guided drainage and IV antibiotics and, after that, made 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.