Serratia Liver Abscess Infection and Cardiomyopathy in a Patient with Diabetes Mellitus: A Case Report and Review of the Literature

Abstract

Patient: Female, 45Final Diagnosis: Serrata liver abscess with diabetes mellitus and cardiomyopathySymptoms: Anxiety • generalized weaknessMedication: —Clinical Procedure: —Specialty: General and Internal MedicineObjective:Rare co-existance of disease or pathologyBackground:Liver abscesses remain difficult to diagnose and treat. Risk factors include diabetes mellitus, liver cirrhosis, and immunodeficiency. The majority are pyogenic, resulting from bacterial infection. Research identifies species in the Serratia genus as the cause of pyogenic liver abscesses in only 0.25% of cases and only 1 Serratia species in each case appears to have been identified. To the best of our knowledge, the present case report is the first to involve overlapping Serratia species in a single liver abscess infection that induced cardiomyopathy.Case Report:A 45-year-old woman presented to our Emergency Department (ED) for severe generalized weakness. Initial test results indicated a diagnosis of microcytic anemia, hypomagnesemia, hypokalemia, hypocalcemia, hyperglycemia, type 2 diabetes mellitus, and severe heart failure. A computed tomography scan showed a 10-cm rim-enhancing fluid collection in the right hepatic lobe. Fluid drained from the suspected abscess tested positive for Serratia marcescens and Streptococcus viridans. The patient was treated with ceftriaxone and metronidazole, which she tolerated well. The abscess decreased to less than 9.8 mm. Twenty-one weeks after discharge, the patient received a cholecystectomy. Fluid drained from the residual abscess cultured positive for a different Serratia species, S. odorifera.Conclusions:Diabetes mellitus and acute cholecystitis were key factors in the initial infections and abscess. We also suspect this is a rare case of cardiomyopathy induced by a Serratia infection. The source of the Serratia odorifera is less certain, as it postdates placement of a percutaneous drain, raising the potential for a nosocomial infection but not precluding the possibility that both Serratia species were previously present.

Infective Endocarditis Due to Serratia odorifera: A Case Report and Literature Review

“…The fourth patient had chronic renal failure with thrombocytopenia and nosocomial sepsis with S. odorifera bacteremia developing following the insertion of a Swan-Ganz catheter [ 11 ]. The patient was able to recover after effective Gram-negative therapy [ 11 , 12 ]. In our search, we did not find documented cases of S. odorifera associated with infective endocarditis.…”

“…Among the four adults that had S. odorifera bacteremia, three of the patients had a source of infection identified as catheter-associated urinary tract infection which had developed following urinary catheterization for surgical procedures [9][10][11][12]. All three patients had chronic renal failure but were still producing urine and were acutely placed on hemodialysis following surgical complications with acute worsening of azotemia [10][11][12]. Two of the patients had liver cirrhosis [10][11][12].…”

“…All three patients had chronic renal failure but were still producing urine and were acutely placed on hemodialysis following surgical complications with acute worsening of azotemia [10][11][12]. Two of the patients had liver cirrhosis [10][11][12]. Of these patients, one succumbed to the overwhelming Gram-negative sepsis [9,10].…”

Right costophrenic angle abscess due to Salmonella Dublin infection in combination with type 2 diabetes mellitus

“…8 Furthermore, diabetes mellitus can lead to abscesses when combined with infection. For example, abscesses can occur in the prostate, 9 liver 10 and brain. 11 During the coinfection of patients with diabetes mellitus, the site of the abscess can occur under the costophrenic.…”