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Asymptomatic pyogenic liver abscesses secondary to Fusobacterium nucleatum and Streptococcus vestibularis in an immunocompetent patient

By: Contributor(s): Publication details: 2017Uniform titles:
  • BMJ Case Reports
Online resources: Summary: <span style="font-size: 10pt;"><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">A 66-year-old male patient presented with symptoms and signs of L4/5 radiculopathy. He was found to be anaemic with elevated inflammatory markers and deranged hepatic enzymes. Imaging revealed lumbar canal stenosis and the presence of pyogenic liver abscesses from which&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Fusobacterium nucleatum</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">&nbsp;and&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Streptococcus vestibularis</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">&nbsp;were isolated. The hepatic abscesses were attributed to asymptomatic diverticular perforation. Multiple coexisting incidental infections were discovered, including oesophageal candidiasis,&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Helicobacter pylori</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">, stool cultures positive for&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Strongyloides stercoralis,</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">&nbsp;and sputum cultures positive for&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Enterobacter cloacae</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">,&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Escherichia coli</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">&nbsp;and&nbsp;</span><em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">Mycobacterium avium</em><span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;">&nbsp;Extensive investigations for possible underlying immunosuppression were negative.</span>&nbsp;</span>
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&lt;span style="font-size: 10pt;"&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;A 66-year-old male patient presented with symptoms and signs of L4/5 radiculopathy. He was found to be anaemic with elevated inflammatory markers and deranged hepatic enzymes. Imaging revealed lumbar canal stenosis and the presence of pyogenic liver abscesses from which&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Fusobacterium nucleatum&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;&amp;nbsp;and&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Streptococcus vestibularis&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;&amp;nbsp;were isolated. The hepatic abscesses were attributed to asymptomatic diverticular perforation. Multiple coexisting incidental infections were discovered, including oesophageal candidiasis,&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Helicobacter pylori&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;, stool cultures positive for&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Strongyloides stercoralis,&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;&amp;nbsp;and sputum cultures positive for&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Enterobacter cloacae&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;,&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Escherichia coli&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;&amp;nbsp;and&amp;nbsp;&lt;/span&gt;&lt;em style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;Mycobacterium avium&lt;/em&gt;&lt;span style="font-family: arial, helvetica, clean, sans-serif; text-align: left;"&gt;&amp;nbsp;Extensive investigations for possible underlying immunosuppression were negative.&lt;/span&gt;&amp;nbsp;&lt;/span&gt;

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