SHM Converge Scientific Abstract ePoster Gallery-Unusual Diverticulitis Complication: Benign Liver Abscesses With Elevated Tumor Markers

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This case report describes a 58-year-old man with alcohol use disorder, recurrent diverticulitis, and portal vein thrombosis who presented with jaundice, tremors, weakness, poor intake, fevers, and night sweats. Initial labs showed leukocytosis, anemia, thrombocytopenia, electrolyte abnormalities, kidney injury, markedly abnormal liver tests, and severe hyperammonemia. CT imaging suggested suspicious hepatic masses and colonic inflammation, raising concern for metastatic malignancy.<br /><br />Further evaluation by surgery, gastroenterology, and hematology/oncology revealed elevated tumor markers, including CA 125 and CA 19-9, which increased suspicion for cancer. However, ultrasound, bloodwork, and biopsy ultimately demonstrated a contained colonic abscess/perforation from diverticulitis with secondary pyogenic liver abscess. Culture grew Streptococcus intermedius. The elevated tumor markers were attributed to inflammation rather than malignancy.<br /><br />The patient underwent drainage and was discharged with three drains, antibiotics, proton pump inhibitors, and close follow-up with gastroenterology, surgery, and hematology. Alcohol cessation was strongly advised.<br /><br />The key teaching point is that CA 125 and CA 19-9 are not specific for cancer and may be elevated in benign inflammatory or hepatobiliary conditions, including liver abscesses and advanced liver disease. This case highlights how diverticulitis can rarely spread through the portal venous system to cause hepatic abscess and how tumor marker elevation can lead to diagnostic confusion. It emphasizes the importance of keeping non-malignant causes in the differential and avoiding premature malignancy assumptions, especially when findings may fit an inflammatory process.

Asset Subtitle

Saranya Madan

Meta Tag

Author List Rabia Mahmood, Rida Jamal, Saranya Madan, Vera Shulgina

Category Clinical Vignettes

Concept Tumor Marker

Concept Diverticulitis

Concept Atypical Hepatic Abscess

Concept Differential Diagnosis

Concept Benign Inflammatory Condition

Distinguished Non-Finalist

Presenter Organization Wayne State University School of Medicine

Presenting Author Saranya Madan

Track Adult

Keywords

diverticulitis

pyogenic liver abscess

portal vein thrombosis

CA 125

CA 19-9

Streptococcus intermedius

hepatobiliary inflammation

colonic perforation

tumor markers

alcohol use disorder

Tumor Marker

Diverticulitis

Atypical Hepatic Abscess

Differential Diagnosis

Benign Inflammatory Condition