SHM Converge Scientific Abstract ePoster Gallery-A Challenging Diagnosis of Streptococcus Intermedius Hepatic Abscess in a Patient With Covid-19

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This case report describes a 72-year-old woman with diverticulosis, prior breast cancer, and recent dental work who presented two days after a COVID-19 diagnosis with cough, congestion, diarrhea, dizziness, hypotension, tachycardia, hypoxia, leukocytosis, hyponatremia, and mildly abnormal liver tests. Because her symptoms overlapped with COVID-19 and possible bacterial pneumonia, she was initially treated with broad-spectrum antibiotics, dexamethasone, and IV fluids.

Blood cultures later grew <em>Streptococcus intermedius</em>, a gram-positive organism known for its tendency to cause abscesses. Although she lacked classic signs of pyogenic liver abscess, persistent fatigue and transaminitis prompted abdominal imaging. Ultrasound showed a necrotic right liver mass concerning for abscess versus tumor, and MRI/CT confirmed a multiloculated hepatic abscess measuring roughly 5.6 x 8 x 5.8 cm.

The suspected source of bacteremia was either recent dental manipulation or diverticular disease. Because the abscess was in a location unsafe for percutaneous drainage, treatment was medical rather than procedural. Antibiotics were narrowed to ceftriaxone, and after clinical improvement she was transitioned to an 8-week course of amoxicillin/clavulanate.

Follow-up imaging four months later showed significant reduction in abscess size to 3.1 x 2.3 cm. The report emphasizes that <em>S. intermedius</em> infections require high clinical suspicion due to their abscess-forming nature and that COVID-19 can obscure the diagnosis because of overlapping symptoms with viral illness.

Asset Subtitle

Emily R. Cosentino

Meta Tag

Author List Emily R. Cosentino, Irina Zaretsky, Kaitlyn Clausell, Natia Pantsulaia, Rahul Gaikwad, Shasawat Kumar

Category Clinical Vignettes

Concept Streptococcus intermedius

Concept Pyogenic Hepatic Abscess

Concept Abscess

Concept Streptococcus intermedius Bacteremia

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside/West

Presenting Author Emily R. Cosentino

Track Adult

Keywords

Streptococcus intermedius

hepatic abscess

bacteremia

COVID-19

diverticulosis

dental work

liver mass

ceftriaxone

amoxicillin-clavulanate

pyogenic abscess

Streptococcus intermedius

Pyogenic Hepatic Abscess

Abscess

Streptococcus intermedius Bacteremia

Antibiotic Therapy