Cryptogenic Pyogenic Liver Abscess Due to Fusobacterium nucleatum in an Immunocompetent Patient

Abstract

In this case, a 76-year-old female presented with 3–4 days of fever with no other localizing signs. Notably, she had had an untreated Fusobacterium bacteraemia approximately 8 weeks prior to admission. She underwent abdominal imaging which demonstrated a liver abscess and had percutaneous drainage of the same. Blood and pus cultures both grew Fusobacterium nucleatum, which is an unusual organism to be associated with a liver abscess, especially in an immunocompetent host with no risk factors for this condition. Interestingly, this patient did not have any history of dental work, instrumentation, liver function test (LFT) abnormalities and no extrahepatic source for the abscess. This case highlights the importance of having a high index of clinical suspicion for an occult source of infection and emphasizes the importance of following up on cultures even after discharge of a patient, since anaerobic infections such as those caused by Fusobacterium can have a largely indolent course.

More Than Just a Periodontal Pathogen –the Research Progress on Fusobacterium nucleatum

“…Regardless, F. nucleatum should be considered a risk factor for CRC, and targeting F. nucleatum in the treatment of CRC may help improve the prognosis of patients with CRC. (Truant et al, 1983;Ford et al, 2005;De Socio et al, 2009;Swidsinski et al, 2011;Lee et al, 2012;Mitsuhashi et al, 2015;Yamamura et al, 2016;Rodrıǵuez Duque et al, 2018;Vander Haar et al, 2018;Hashemi Goradel et al, 2019;Abushamma et al, 2020;Barrera-López et al, 2020;Boehm et al, 2020;Cao et al, 2020;Huang et al, 2020;Kenig et al, 2020;Parhi et al, 2020;Swaminathan and Aguilar, 2020;Hoffmeister et al, 2021).…”

P. micra and F. necrophorum: Hepatic Abscesses in a Healthy Soldier

“…There have been reported cases of young, otherwise healthy patients getting hepatic abscesses from Fusobacterium . The most common initial symptoms described in these cases are fever, chills, and diarrhea, ranging from 3 to 14 days prior to presentation [ 8 , 13 , 15 ]. Case reports include an otherwise healthy 21-year-old male, a 54-year-old male with concomitant lung abscesses and acute diverticulitis, and a 76-year-old female with preceding Fusobacterium bacteremia [ 8 , 13 , 15 ].…”

“…The most common initial symptoms described in these cases are fever, chills, and diarrhea, ranging from 3 to 14 days prior to presentation [ 8 , 13 , 15 ]. Case reports include an otherwise healthy 21-year-old male, a 54-year-old male with concomitant lung abscesses and acute diverticulitis, and a 76-year-old female with preceding Fusobacterium bacteremia [ 8 , 13 , 15 ]. Fusobacterium is associated with periodontal disease, and one case report suggests that even routine dental cleaning can lead to Fusobacterium bacteremia and abscess formation [ 9 ].…”

“…Fusobacterium is associated with periodontal disease, and one case report suggests that even routine dental cleaning can lead to Fusobacterium bacteremia and abscess formation [ 9 ]. Fortunately in these specific case reports, each patient clinically improved after abscess drainage and antibiotic therapy [ 8 , 9 , 13 , 15 ].…”

Giant Liver Infections: Cryptogenic Liver Abscess Secondary to Bacteroides Fragilis

“…Despite sophistication in diagnostic imaging, cryptogenic PLAs are quite frequent. A PLA is cryptogenic when no extrahepatic source is identified [6].…”