Look in the liver

A 72 year type 2 diabetic man presented to hospital after collapsing. For the preceding several months his glycemic control had deteriorated and in the weeks leading to admission he got progressively more unwell in a non-specific fashion. He had been generally well before this illness but did have poor dentition leading to a presumptive diagnosis of bacterial endocarditis that was supported by the finding of Gram-positive cocci in chains in multiple blood cultures.

The organism isolated in blood was identified as Streptococcus intermedius – one of three species that comprise the “Streptococcus anginosus group”. The finding of this specific species prompted the suggestion of investigating for the possibility of organ abscess and a CT scan of his abdomen was performed.

S. anginosus Liver1

Streptococcus anginosus

As demonstrated by this case de-novo liver abscesses caused by the S. anginosus group can be very large. This one had replaced almost half of the liver, greater than 700 mL in volume. Patients are generally non-specifically unwell for several weeks before presentation, with fevers, malaise, and weight loss featuring prominently. When blood cultures reveal streptococci, subacute bacterial endocarditis is often considered and the presentation is often clinically similar.

Percutaneous drainage with CT guidance is usually possible and results in prompt improvement. S. anginosus is almost uniformly susceptible to penicillin.

Category: GI infection

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