SHM Converge Scientific Abstract ePoster Gallery-Hepatic and Brain Abscesses of Unknown Origin

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This case describes a 63-year-old obese, immunocompetent woman who presented with chills and generalized abdominal pain and was found to have both hepatic and brain abscesses without an obvious source. Initial labs showed leukocytosis, and blood cultures grew <em>Peptonophilus asaccharolyticus</em>, a rare opportunistic anaerobic commensal. Abdominal CT revealed a large right liver abscess with smaller surrounding abscesses. She was treated with empiric antibiotics and CT-guided drainage, which improved her abdominal symptoms. 

During hospitalization, she developed encephalopathy, and brain MRI showed two small right parietal abscesses. Her mental status returned to baseline with antibiotics alone, and she did not require neurosurgical intervention. Repeat imaging later showed resolution of both hepatic and brain abscesses.

Several common causes of brain and liver abscesses were not identified. She had no history of malignancy, transplant, IV drug use, trauma, or head/neck infection. HIV testing was negative, and transesophageal echocardiography showed no endocarditis or structural heart disease. About six months later, she was readmitted with bloody diarrhea and diagnosed with severe ulcerative colitis, which improved rapidly with infliximab. The authors suggest that newly recognized inflammatory bowel disease may explain the liver abscess and possibly contributed to the overall infectious process, though the link to the brain abscess remains uncertain.

The case highlights that brain abscesses can sometimes be successfully managed with antibiotics alone, and that unusual intra-abdominal infection may precede the diagnosis of inflammatory bowel disease.

Asset Subtitle

Charles S. Lamberton

Meta Tag

Author List Charles S. Lamberton, Colin Martyn, Spencer Bonnerup

Category Clinical Vignettes

Concept Pyogenic Hepatic Abscess

Concept Cerebral Abscess

Concept Hematogenous Spread

Concept Contiguous Spread

Concept Empiric Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Indiana University Southwest Internal Medicine Residency

Presenting Author Charles S. Lamberton

Track Adult

Keywords

hepatic abscess

brain abscess

Peptonophilus asaccharolyticus

anaerobic bacteremia

ulcerative colitis

inflammatory bowel disease

CT-guided drainage

encephalopathy

immunocompetent patient

antibiotic therapy

Pyogenic Hepatic Abscess

Cerebral Abscess

Hematogenous Spread

Contiguous Spread

Empiric Antibiotic Therapy