SHM Converge Scientific Abstract ePoster Gallery-Fusobacterium Nucleatum, an Underrated Cause of Colorectal Cancer

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This case report describes a 60-year-old man who presented with fever, chills, abdominal pain, vomiting, distention, hypotension, elevated lactate, and acute kidney injury. CT imaging showed multiple pyogenic liver abscesses causing intrahepatic biliary obstruction. He was treated for septic shock with vasopressors, broad-spectrum antibiotics, and later percutaneous drainage of the abscesses. Blood and abscess cultures grew <em>Fusobacterium nucleatum</em>.

Because <em>F. nucleatum</em> has been increasingly linked to colorectal cancer, follow-up imaging and colonoscopy were performed. CT revealed a cecal mucosal lesion, and colonoscopy identified a flat elevated lesion with central depression. Biopsy confirmed invasive adenocarcinoma. Due to recurrent bleeding and the malignancy, the patient underwent right hemicolectomy with end ileostomy. Final pathology showed adenocarcinoma invading the muscularis propria with negative margins.

The report emphasizes the emerging role of <em>F. nucleatum</em> in colorectal carcinogenesis. Proposed mechanisms include bacterial virulence factors such as Fap2, which promotes tumor affinity and proliferation, and FadA, which activates oncogenic β-catenin signaling. The organism may also help tumors evade immune surveillance by affecting myeloid cells and natural killer cells.

The main clinical takeaway is that <em>F. nucleatum</em> bacteremia or liver abscesses should prompt evaluation for an underlying colonic malignancy. The authors also note that stool DNA testing for <em>F. nucleatum</em> has been explored as a potential CRC screening tool. Further research into gut dysbiosis may improve cancer risk identification and screening strategies.

Asset Subtitle

John C. Hardy

Meta Tag

Author List John C. Hardy, Julia Timm-Intilli, Kaiser Lahm

Category Clinical Vignettes

Concept Fusobacterium nucleatum

Concept Colorectal Cancer

Concept Bacteremia

Concept Pyogenic Hepatic Abscess

Concept Fap2

Distinguished Non-Finalist

Presenter Organization San Antonio Military Medical Center

Presenting Author John C. Hardy

Track Adult

Keywords

Fusobacterium nucleatum

pyogenic liver abscess

colorectal cancer

septic shock

bacteremia

colon adenocarcinoma

right hemicolectomy

intrahepatic biliary obstruction

Fap2 virulence factor

FadA signaling

Fusobacterium nucleatum

Colorectal Cancer

Bacteremia

Pyogenic Hepatic Abscess

Fap2