Englewood Hospital and Medical Center Englewood, NJ
Esraa Mohamed, MD, Shalva Eliava, MD, Chadane Thompson, MD, Alyssa Foster, MD Englewood Hospital and Medical Center, Englewood, NJ Introduction: Pyogenic liver abscess (PLA) is uncommon in developed countries, with an annual incidence of 2.3–3.6 cases per 100,000. Fusobacterium, a group of facultative anaerobic gram-negative bacilli, rarely cause PLA and are typically linked to periodontal or gastrointestinal (GI) disease. The co-occurrence of PLA and acute portal vein thrombosis (PVT) due to Fusobacterium nucleatum is particularly unusual, especially in immunocompetent patients. We present a case of PLA and PVT due to F. nucleatum associated with sigmoid diverticulitis.
Case Description/
Methods: An 82-year-old woman with hypertension and hypothyroidism presented with a one-week history of fatigue, poor appetite, mild constipation, and hematochezia. Labs showed leukocytosis (WBC 16.1 K/µL, neutrophils 89.8%), anemia (Hgb 10 g/dL), thrombocytosis (platelets 435 K/µL), elevated liver enzymes (ALP 295 U/L, AST 44 U/L, ALT 59 U/L), total bilirubin 1.0 mg/dL, hypoalbuminemia (2.9 g/dL), and acute kidney injury (creatinine 1.42 mg/dL). CT abdomen/pelvis showed right PVT and adjacent hepatic hypoattenuation (largest 5.1 cm × 3.8 cm), suggestive of infection. MRI confirmed right PVT, patchy ill-defined hepatic lesions, sigmoid colonic wall thickening, and no drainable abscess or mass.
Cefepime and metronidazole were started empirically for presumed liver infection and diverticulitis, along with anticoagulation for the PVT. However, the patient deteriorated and was transferred to the intensive care unit with septic shock requiring vasopressors. Blood cultures grew F. nucleatum; hence, an inpatient colonoscopy was performed to rule out GI malignancy. This revealed pan-diverticulosis, mild sigmoid erythema (pathology was consistent with chronic colitis), and two small tubular adenomas. The patient was treated with four weeks of intravenous antibiotics as interventional radiology deemed the lesions non-drainable. A follow-up CT abdomen at 6 weeks showed resolution of the hepatic lesions. Discussion: F. nucleatum is an uncommon cause of PLA, likely reaching the liver via mucosal translocation. In our case, there was no active periodontal disease, so colonoscopy was warranted to rule out occult GI malignancy but it showed that the likely source was the sigmoid diverticulitis. While drainage is standard in the management of PLA, diffuse non-drainable lesions may respond to antibiotics alone, especially with susceptible organisms. Early diagnosis, use of appropriate antibiotics, and close monitoring are key steps in ensuring favorable clinical outcomes.
Disclosures: Esraa Mohamed indicated no relevant financial relationships. Shalva Eliava indicated no relevant financial relationships. Chadane Thompson indicated no relevant financial relationships. Alyssa Foster indicated no relevant financial relationships.
Esraa Mohamed, MD, Shalva Eliava, MD, Chadane Thompson, MD, Alyssa Foster, MD. P3929 - A Rare Case of Pyogenic Liver Abscess and Portal Vein Thrombosis Due to <i>Fusobacterium nucleatum</i>, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
