Multiple liver abscesses caused by Streptococcus intermedius

A 40-year-old woman without any clinical history was admitted for fever and discomfort in her right upper abdomen for 2 weeks. She denied headaches, recent travel, recent dental procedures, and recreational drug use. She was noted to have dental caries. Physical examination revealed tenderness in the right upper abdomen and percussion pain in the hepatic area. The white cell count was 15.7×10⁹/L, with 83.1% neutrophils. Abdominal plain computed tomography (CT) revealed that the liver was full of multiple low-density cysts. Enhanced CT revealed no enhancement of the central necrotic areas but revealed uneven enhancement of the cystic walls (yellow arrows) and edema of the surrounding liver parenchyma (Figure 1A). Abdominal ultrasound revealed multiple hypoechoic and mixed-echo masses with thick cystic walls (white arrows) and clear margins, without blood flow signals or contrast enhancement within the lesions (Figure 1B, left, contrast-enhanced; right, two-dimensional). Multiple liver abscesses were considered the diagnosis. Blood culture and ultrasound-guided cyst drainage were performed; both methods captured Streptococcus intermedius as the pathogen. No abscess was found on head or chest CT scans. The patient was given antibiotics for 4 weeks and followed up for 1 year, after which the liver abscesses had dissipated on enhanced CT and contrast-enhanced ultrasound.

Figure 1 Images of liver lesions. (A) Multiple cystic, low-density shadows with thick cystic walls (yellow arrows) by enhanced CT; (B) multiple hypoechoic and mixed echo masses with thick cystic walls (white arrows) by contrast-enhanced (left panel) and two-dimensional ultrasound (right panel). CT, computed tomography.

Acknowledgments

Thank you to Professor Rongbo Liu from the Department of Radiology at West China Hospital, Sichuan University, for providing guidance on image selection and interpretation.

Funding: This work was supported by National Key Research and Development Program of China (grant number 2021YFC2501800).

Footnote

Provenance and Peer Review: This article was a standard submission to the journal. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://hbsn.amegroups.com/article/view/10.21037/hbsn-24-343/coif). The authors reports that this work was supported by National Key Research and Development Program of China (grant number 2021YFC2501800). The authors have no other conflicts of interest to declare.

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