P6160 - An Unexpected Infection: Diagnosing a Liver Abscess in a Young, Healthy Adult

James R. Laney, MD, Samuel Igbinedion, MD, Sean Rice, MD, Haseeb Mohideen, MD, Andrew Robert. Mims, MD
University of Tennessee Health Science Center, Chattanooga, TN

Introduction:

A pyogenic liver abscess (PLA) is an uncommon pathology that can develop from a wide spectrum of clinical sources. Pathogenesis is most typically seen as abscess development in the context of underlying biliary tract disease such as gallstone or malignant obstruction, direct spread from penetrating trauma, seeding from an arterial source, or portal pyemia from bowel leakage or peritonitis. This case serves as an example of PLA of cryptogenic origin

Case Description/

Methods: The patient was a 38-year-old caucasian male with a history of HTN and GERD who presented with worsening RUQ pain and fevers. Six weeks prior, he had malaise and diarrhea, and was diagnosed with mononucleosis. Symptoms persisted with RUQ pain, poor PO intake, and 30 lb weight loss. He also had flank pain and dark urine; renal US showed an incidental liver lesion. He developed fevers and presented to ED. Labs: WBC 11.9, Alk Phos 428, ALT 91, AST 48, T-bili 0.5, Hgb 10.5. CT showed 6×8×9 cm thick-walled cavitary mass in posterior right hepatic lobe, consistent with hepatic abscess. Blood and stool cultures were negative; HIV was negative. The patient had no prior history of travel outside of the US, alcohol, or drug use. MRCP and colonoscopy were unremarkable. Patient was started started on Zosyn and underwent IR-guided drainage with cultures positive for E. coli. Antibiotics were deescalated to Flagyl and TMP/SMX. Following drain placement, the patient's symptoms significantly improved and he was discharged with drain intact and a 4-week antibiotic plan

Discussion: Cryptogenic PLA is a rare pathology with a worldwide incidence of 1 in 50,000 individuals. However, the vast majority of these cases occur within Asia, with Klebsiella Pneumoniae as the most frequent pathogen. The role of screening colonoscopy in patients with cryptogenic PLA is crucial as this population has been found to have increased risk for CRC. Similar to those with CRC, patients with IBD have a pathophysiology that involves inflammation leading to disruption of the colonic mucosal barrier. While this patient’s colonoscopy was grossly normal, he was taking omeprazole outpatient. Though poorly understood, studies both abroad and in the US have shown that PPIs are associated with increased risk of developing PLA. The scope of this association remains unclear, and this case serves as an example of the need for further studies examining the relationship of PPIs in patients with PLA without apparent origin


Figure: Figure A: Right upper quadrant ultrasound imaging of hepatic abscess. Figure B: Abdominal CT scan showing hepatic abscess. Abdominal MRI scan of hepatic abscess

Disclosures:
James Laney indicated no relevant financial relationships.
Samuel Igbinedion indicated no relevant financial relationships.
Sean Rice indicated no relevant financial relationships.
Haseeb Mohideen indicated no relevant financial relationships.
Andrew Mims indicated no relevant financial relationships.

James R. Laney, MD, Samuel Igbinedion, MD, Sean Rice, MD, Haseeb Mohideen, MD, Andrew Robert. Mims, MD. P6160 - An Unexpected Infection: Diagnosing a Liver Abscess in a Young, Healthy Adult, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.