Ileal GIST presenting with bacteremia and liver abscess: A case report and review of literature

Abstract

HighlightsSmall intestine gastrointestinal stromal tumors can infrequently present with intra-abdominal abscess, perforation, obstruction or fistula.Tumor-small intestine fistula is a rare phenomenon and occurs as a result of GISTs’ propensity to cause mucosal ulceration.Although liver metastases are common, in the rare case of a GIST complicated by gastrointestinal tract perforation, abscess or fistula, a pyogenic liver abscess is another important entity to consider.Positive blood cultures with members of the S. milleri group should prompt consideration of occult abdominal infection, perforation and gastrointestinal malignancy.

Gastrointestinal Stromal Tumor Complicated by Fistula Formation

“…2 Although there have been isolated case reports of GISTs presenting with enterocolic or vesicocutaneous fistulas, these patients often presented with overt clinical signs or symptoms as mentioned. 4 By contrast, our patient's fistula was found incidentally during workup for an unrelated anemia. Radiographic evidence of fistulization may include the presence of air fluid levels within the suspected mass.…”

An Unusual Case of Suspected Metastatic Gastrointestinal Stromal Tumor Complicated by Streptococcus Intermedius Pyogenic Liver Disease

“…A review of the literature has demonstrated that primary liver abscesses when associated with primary GIST are often caused by commensal, obligate, or facultative anaerobic organisms [ 17 ]. Alpha hemolytic streptococcus infections, which are part of the mucosal flora of the GI tract, such as Streptococcus milleri and Streptococcus intermedius, have been implicated [ 17 , 18 ]. While there are limited data on liver abscesses and primary GIST, common causes of pyogenic liver abscesses are related to hepatic malignancy, biliary tract disease, and gut microbiota dysbiosis [ 17 ].…”

“…Emerging studies have also noted a relationship between gut microbiota dysbiosis and the development of GIST, which we would recommend further exploration [ 19 ]. Nonetheless, if there is a concern for liver metastasis, it is recommended that patients undergo diagnostic workup for pyogenic liver abscesses as well, so they are promptly initiated on appropriate antibiotics [ 18 ]. Conversely, the identification of an alpha-hemolytic streptococcus infection or, generally, an anaerobic infection should prompt further evaluation of GI tract malignancies [ 18 ].…”

“…Nonetheless, if there is a concern for liver metastasis, it is recommended that patients undergo diagnostic workup for pyogenic liver abscesses as well, so they are promptly initiated on appropriate antibiotics [ 18 ]. Conversely, the identification of an alpha-hemolytic streptococcus infection or, generally, an anaerobic infection should prompt further evaluation of GI tract malignancies [ 18 ]. Our patient was discharged on ertapenem via PICC line; however, due to the unknown ratio of hepatic abscess to tumor burden, a specified course of antibiotics could not be defined.…”

Case Report on Rare Outcome of a Retroperitoneal Mass: Management Challenges and Lessons Learnt

“…Gorelik et al [7] reported another rare presentation of GIST. The patient presented in bacteraemia with liver abscess.…”