SHM Converge Scientific Abstract ePoster Gallery-Pyogenic Liver Abscess Masquerading as a Hepatic Tumor

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This case describes a 61-year-old man with no significant past medical history who presented with one week of malaise and exertional dyspnea after a dental procedure six weeks earlier. On admission, he was febrile, tachycardic, tachypneic, and hypoxic, with marked leukocytosis, thrombocytopenia, acute kidney injury, lactic acidosis, and abnormal liver tests. Initial abdominal ultrasound and non-contrast CT showed a large heterogeneous central liver lesion involving both lobes, raising concern for cirrhosis, hepatoma, metastatic disease, or abscess.<br /><br />Because renal failure limited contrast imaging, he was treated empirically for sepsis with broad-spectrum antibiotics. Blood cultures grew Streptococcus intermedius, and tumor markers (AFP, CA 19-9, CEA) were normal. Echocardiography was negative for endocarditis. His antibiotics were narrowed to ceftriaxone, and repeat blood cultures cleared. As renal function improved, MRI with contrast was performed and demonstrated a multiloculated 11.3 cm hepatic lesion most compatible with pyogenic liver abscess rather than malignancy. The abscess was not suitable for percutaneous drainage, so he underwent laparoscopic ultrasound-guided drainage. Drain cultures were negative, but he improved clinically and was discharged on six weeks of intravenous ceftriaxone. Follow-up imaging four weeks later showed resolution of the abscess.<br /><br />The key lesson is that pyogenic liver abscess can closely mimic hepatic malignancy on imaging, especially when diagnostic options are limited. Careful clinical correlation, microbiologic data, and timely reassessment are essential to reach the correct diagnosis and guide appropriate treatment.

Asset Subtitle

Kishan G. Patel

Meta Tag

Author List Kishan G. Patel, Neha Shiveshvarkar

Category Clinical Vignettes

Concept Pyogenic Hepatic Abscess

Concept Broad-Spectrum Antibiotic

Concept Drainage

Concept Systemic Symptoms

Concept Sepsis

Distinguished Non-Finalist

Presenter Organization Nuvance Health

Presenting Author Kishan G. Patel

Track Adult

Keywords

pyogenic liver abscess

Streptococcus intermedius

hepatic lesion

sepsis

differential diagnosis

MRI contrast

laparoscopic drainage

broad-spectrum antibiotics

acute kidney injury

liver abscess resolution

Pyogenic Hepatic Abscess

Broad-Spectrum Antibiotic

Drainage

Systemic Symptoms

Sepsis