SHM Converge Scientific Abstract ePoster Gallery-The Curious Liver

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This pediatric case describes a 14-year-old immunocompetent boy who presented with 6 days of fever, right-sided abdominal pain, headache, and bilateral neck/shoulder pain. Exam showed abdominal distension and guarding, with mild respiratory distress. Labs revealed elevated inflammatory markers and mild liver enzyme abnormalities. Imaging demonstrated a large lobulated left liver mass and a smaller right hepatic cystic lesion with biliary dilatation and ascites, raising concern for liver abscesses.<br /><br />The differential diagnosis included zoonotic infection, Lemierre’s syndrome, intussusception, inflammatory bowel disease, dental source, chronic granulomatous disease, and other infectious or immunodeficiency-related causes. Blood cultures were negative, and neutrophil oxidative burst testing was normal, helping rule out chronic granulomatous disease.<br /><br />He was initially treated with piperacillin/tazobactam. Interventional radiology drained 40 mL of foul-smelling bloody fluid and placed a JP drain. Culture of the abscess grew Fusobacterium nucleatum. The patient then completed 6 weeks of ertapenem followed by 2 weeks of metronidazole, with clinical improvement, decreasing inflammatory markers, and improved imaging findings.<br /><br />The authors conclude that liver abscesses in immunocompetent children are rare, especially those linked to dental procedures. This case appears to be the first known pediatric immunocompetent liver abscess caused by F. nucleatum. It emphasizes the need for a broad differential diagnosis and prompt evaluation and treatment because hepatic abscesses can be life-threatening.

Asset Subtitle

Emily A. Kragel

Meta Tag

Author List Bram Rickett, Emily A. Kragel, Giselle Fernandes, Natasha K. Kajani

Category Clinical Vignettes

Concept Hepatosplenic Abscess

Concept Pediatric Liver Abscess

Concept Fusobacterium nucleatum

Concept Interventional Drainage

Concept Antibiotic Therapy

Distinguished Non-Finalist

Presenter Organization Kaiser Permanente- Oakland

Presenting Author Emily A. Kragel

Track Pediatric

Keywords

pediatric liver abscess

immunocompetent child

Fusobacterium nucleatum

hepatic abscess

fever and abdominal pain

interventional radiology drainage

biliary dilatation

ascites

ertapenem therapy

metronidazole treatment

Hepatosplenic Abscess

Pediatric Liver Abscess

Fusobacterium nucleatum

Interventional Drainage

Antibiotic Therapy