Pyogenic liver abscess secondary to disseminated Streptococcus Anginosus from Sigmoid Diverticulitis

Abstract

Pyogenic liver abscess secondary to dissemination from Sigmoid Diverticulitis is rare. Streptococcus Anginosus has been linked to abscesses but has been rarely reported from a Sigmoid Diverticulitis source. We report a case of liver abscess in which the source was confounding but eventually was traced to Sigmoid Diverticulitis on laparotomy.

Pyogenic liver abscess: uncommon presentation

“…As described by Oschner et al 6 and Norman and Yoshikawa,7 this clinical entity does not have specific clinical characteristics, and hence the need for a high index of suspicion for an early diagnosis 4. Radiology plays a crucial role in recognition of suggestive imaging features of this lesion.…”

“…Its incidence is about 1–45/100 000,1 with peak incidence in the fifth decade of life, but growing in the older population2 whose clinical presentation is atypical and more subtle 1. The increasing incidence in older age groups is due to the improvement of antibiotics allowing a more aggressive treatment of intra-abdominal infections typical of the young, so that abscesses occur in association with common clinical conditions in older age,3 namely: hepatobiliary pathology (gallstones, strictures, congenital diseases and cancer);4 diverticular disease and malignant neoplasms of the colon, which are currently the most prevalent group.…”

“…If it is not possible to isolate the agent to perform a cultural examination and antibiotics sensibility test, an antibiotics scheme should be started empirically. When possible, adjust the sensitivity of the isolated microorganism; it can be indeed curative if the abscess is smaller than 5 cm in diameter 4. Although empirical antibiotics schemes are none of the above, the literature shows good response rates.…”

“…Although empirical antibiotics schemes are none of the above, the literature shows good response rates. Percutaneous drainage in combination with systemic antibiotics is a safe and effective treatment and should be considered as first-line for PLA with abscesses 5–7.3 cm in diameter in patients with sustained fever for >24–48 h even under therapy or if there is a clinical or imaging suggestion of abscess perforation 2 4. The bigger the distance between the PLA liver capsules, the bigger the likelihood of successful percutaneous drainage 1.…”

Cavernosal Abscess due to Streptococcus Anginosus : A Case Report and Comprehensive Review of the Literature

“…Systemic SMG infections are often associated with breakdown in gastrointestinal epithelium, as in dental abscesses [26], ingested foreign bodies [24], and gastrointestinal malignancies [27,28,29]. Murarka et al [30] reported a case of liver abscess secondary to disseminated S. anginosus from sigmoid diverticulitis. Our patient had evidence of proctitis on CT scan, which was the likely source of S. anginosus bacteremia with possible intravascular infection subsequently seeding the corpus cavernosum.…”