SHM Converge Scientific Abstract ePoster Gallery-Recurrent Fusobacterium Nucleatum Liver Abscess Complicated by Multiple Intracerebral Abscesses

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This case report describes a 44-year-old immunocompetent man with a prior history of Fusobacterium nucleatum (FN) liver abscess, successfully treated two years earlier, who later presented with three weeks of confusion, expressive aphasia, fever, and ataxia. Imaging of the brain showed numerous ring-enhancing lesions consistent with multiple intracerebral abscesses. Abdominal imaging revealed a recurrent 6.8 cm hepatic mass consistent with liver abscess and focal sigmoid colon thickening concerning for malignancy.<br /><br />Initial workup, including CSF studies and broad infectious testing, was largely unrevealing. The patient was treated empirically with ceftriaxone, vancomycin, and metronidazole. Hepatic abscess drainage produced pus, but cultures were negative. Blood cultures remained negative, and a plasma cell-free DNA Karius test also did not identify a pathogen. Because diagnosis remained uncertain, biopsy/drainage of the brain lesions was pursued. FN was ultimately identified from brain biopsy culture using 16S/18S rRNA sequencing.<br /><br />The patient improved clinically after targeted therapy, and a prolonged course of ceftriaxone plus metronidazole was planned. Follow-up showed significant recovery.<br /><br />The report emphasizes that FN is an anaerobic gram-negative organism normally found in the oral cavity but capable of causing serious extraoral infections, including abscesses, colorectal disease, and Lemierre’s syndrome. Simultaneous liver and brain abscesses due to FN are rare, especially in immunocompetent patients without major risk factors. It also highlights the diagnostic challenge of FN infection when routine cultures are negative and suggests that molecular methods such as 16S rRNA sequencing may be crucial when anaerobic infection is suspected.

Asset Subtitle

Om Parkash

Meta Tag

Author List Amulya Dawaram, Maryna Shayuk, Om Parkash, Saad Khan, Shreya Patel, Syeda Tooba Ali

Category Clinical Vignettes

Concept Fusobacterium nucleatum

Concept Hepatosplenic Abscess

Concept Cerebral Abscess

Concept Culture-Negative Infection

Concept Anaerobic Infection

Distinguished Non-Finalist

Presenter Organization Northwestern Medicine McHenry Hospital

Presenting Author Om Parkash

Track Adult

Keywords

Fusobacterium nucleatum

brain abscess

liver abscess

immunocompetent

ring-enhancing lesions

16S rRNA sequencing

anaerobic infection

sigmoid colon thickening

culture-negative abscess

ceftriaxone metronidazole

Fusobacterium nucleatum

Hepatosplenic Abscess

Cerebral Abscess

Culture-Negative Infection

Anaerobic Infection