SHM Converge Scientific Abstract ePoster Gallery-An Uncommon Cause of Chest Pain: Multiloculated Hepatic Abscess in a Patient With Strongyloides Stercolaris Infection

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This case report describes an unusual presentation of a pyogenic liver abscess in a 53-year-old man who had recently emigrated from El Salvador and presented with eight days of intermittent substernal chest pain, palpitations, chills, shortness of breath, and diaphoresis. He had no abdominal pain or tenderness, making the diagnosis less obvious.<br /><br />Initial evaluation showed junctional tachycardia, inferior lead T-wave inversions, leukocytosis, markedly elevated lactate, mild liver enzyme elevation, and elevated troponin. CTA of the chest was negative for pulmonary embolism but incidentally revealed a heterogeneous liver mass. Abdominal CT confirmed a large multiloculated abscess in the right and caudate hepatic lobes. Workup for amoebic and immunodeficiency causes was negative, but blood cultures grew Klebsiella pneumoniae, and stool testing identified Strongyloides stercoralis larvae.<br /><br />The patient developed septic shock and was treated with ceftriaxone and metronidazole for four weeks, along with ivermectin for strongyloidiasis. Interventional radiology advised against drainage because of the abscess’s complexity and location. Follow-up CT after treatment showed complete resolution.<br /><br />The authors emphasize that pyogenic liver abscess is uncommon in North America and usually presents with fever, right upper quadrant pain, nausea, or vomiting. Klebsiella pneumoniae is an increasingly common cause, especially in patients with diabetes. Chronic strongyloidiasis may increase susceptibility to severe Klebsiella infection, possibly by damaging intestinal mucosa and promoting bacterial dissemination. This case highlights that liver abscess can present atypically with chest pain and cardiac findings due to sepsis-related demand ischemia. Early recognition and treatment are critical, as untreated liver abscess can be fatal.

Asset Subtitle

Yaritza Serrano Gomez

Meta Tag

Author List Ijeoma v. Aneke, James Mumford MD, Yaritza Serrano Gomez

Category Clinical Vignettes

Concept Pyogenic Hepatic Abscess

Concept Hepatosplenic Abscess

Concept Klebsiella pneumoniae

Concept Strongyloides stercoralis

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Northwell Health

Presenting Author Yaritza Serrano Gomez

Track Adult

Keywords

pyogenic liver abscess

Klebsiella pneumoniae

Strongyloides stercoralis

septic shock

chest pain

junctional tachycardia

liver abscess

amoebic infection

ceftriaxone

ivermectin

Pyogenic Hepatic Abscess

Hepatosplenic Abscess

Klebsiella pneumoniae

Strongyloides stercoralis

Antibiotic Therapy