SHM Converge Scientific Abstract ePoster Gallery-When Standard Drainage Fails: Case of a Fusobacterium Necrophorum Liver Abscess in a Young Female

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This case report describes an unusual pyogenic liver abscess (PLA) caused by <strong>Fusobacterium necrophorum</strong> in an <strong>18-year-old female</strong> with newly diagnosed <strong>type 1 diabetes mellitus</strong> and no clear biliary or intra-abdominal source. PLAs are uncommon in young adults, and anaerobic causes like <em>F. necrophorum</em> are especially rare.

The patient presented with <strong>five weeks of intermittent fevers, malaise, myalgias</strong>, and then acute <strong>right shoulder and pleuritic chest pain</strong>. CT imaging showed a <strong>large right hepatic lobe abscess</strong> measuring <strong>7.8 × 11.4 cm</strong>. Percutaneous drainage was performed, and cultures grew <strong>F. necrophorum</strong>; blood cultures were negative. She was treated with <strong>IV ampicillin-sulbactam</strong>.

Despite initial drainage, her <strong>alkaline phosphatase rose significantly</strong> (187 to 600 U/L), raising concern for treatment failure. However, repeat CT on hospital day 6 showed <strong>partial abscess improvement</strong> but also <strong>new perihepatic fluid collections</strong>, suggesting <strong>incomplete source control</strong> rather than antibiotic failure. Because drain output remained minimal and complications occurred, the drain was removed on hospital day 8. She was then transitioned to <strong>oral amoxicillin-clavulanate</strong> and discharged with close follow-up.

Over time, she had <strong>marked radiographic improvement</strong> and <strong>complete clinical resolution</strong> after <strong>3 months of oral therapy</strong>. The abscess shrank to <strong>2.6 × 5.4 cm</strong>, and alkaline phosphatase fell to <strong>384 U/L</strong>.

Key takeaways:  
- <em>F. necrophorum</em> should be considered in <strong>cryptogenic PLA in young adults</strong>.  
- Rising cholestatic enzymes do <strong>not always mean antimicrobial failure</strong>.  
- <strong>Oral step-down therapy</strong> can be effective even before full radiographic resolution if the patient is clinically stable.  
- Careful follow-up and culture-directed anaerobic coverage are essential for successful management.

Asset Subtitle

Brandon M. Block

Meta Tag

Author List Brandon M. Block, Cody Jinnette, Grace Young

Category Clinical Vignettes

Concept Pyogenic Hepatic Abscess

Concept Fusobacterium necrophorum

Concept Percutaneous Drainage

Concept Microbiology-directed antimicrobial therapy

Concept Etiology

Distinguished Non-Finalist

Presenter Organization Indiana University School of Medicine

Presenting Author Brandon M. Block

Track Adult

Keywords

pyogenic liver abscess

Fusobacterium necrophorum

type 1 diabetes mellitus

young adult

anaerobic infection

cryptogenic abscess

percutaneous drainage

ampicillin-sulbactam

amoxicillin-clavulanate

oral step-down therapy

Pyogenic Hepatic Abscess

Fusobacterium necrophorum

Percutaneous Drainage

Microbiology-directed antimicrobial therapy

Etiology