Small Bowel Gastrointestinal Stromal Tumor as a Gateway for Streptococcus anginosus Causing Multiple Liver Abscesses

Abstract

Gastrointestinal stromal tumors (GISTs) are the most common type of mesenchymal neoplasm of the gastrointestinal tract but consist of only 1% of all primary gastrointestinal neoplasms. Differentiated from other spindle cell tumors, GISTs are uniquely positive for CD117 expression which allows for molecular targeting therapy with imatinib mesylate (Gleevec). Clinical presentations are variable, ranging from asymptomatic to vague symptoms of abdominal pain, early satiety, abdominal distention or gastrointestinal bleeding. Very rarely, patients can present with tumor-bowel fistula and intra-abdominal abscesses. In this article, we discuss a rare presentation of a middle-aged male with multiple liver abscesses found to have a primary small bowel GIST. This patient received prompt intravenous antibiotics; however, hepatic abscesses can be easily misinterpreted as cystic hepatic metastases which can delay appropriate therapy. Streptococcus anginosus was found to be responsible for the formation of the liver abscesses visualized on computed tomography (CT) scan. Similar to Streptococcus bovis, knowledge in the literature is arising about the association between S. anginosus and gastrointestinal malignancies. This case highlights the importance of identifying concomitant primary GISTs with intra-hepatic abscesses, as these lesions can be easily misconstrued as liver metastases and consequently mismanaged. We herein emphasize that hepatic abscesses are a potential sequela of GISTs and should thus prompt further investigation for potential malignancies, if warranted, so that there is no delay in treatment of these gastrointestinal tumors.

Global compositional and functional states of the human gut microbiome in health and disease

“…This is particularly true for representatives of the Streptococcus genus. Many of the streptococcal species identified here are members of the viridans group Streptococci , a diverse group that has members associated with disease and polymicrobial infection (e.g., S. anginosus , associated with liver and soft tissue abscesses) ( Conte et al 2020 ), as well as members that have been proposed for use as probiotics (e.g., S. salivarius ) ( Shen et al 2014 ; Riaz Rajoka et al 2017 ). We recently found that the translocation of oral bacteria to the gut may lead to systemic inflammation during disease pathogenesis, including liver cirrhosis, and rifaximin treatment may prevent this oralization, thereby improving disease symptoms, including hepatic encephalopathy ( Patel et al 2022 ).…”