Pyogenic liver abscess: uncommon presentation

Pyogenic Liver Abscess Growing Streptococcus constellatus in an Elderly Female With Recent Diverticulitis: A Case Report

Pyogenic liver abscess (PLA) is known as a pus-filled lesion found in the liver which can quickly become fatal if not found and treated in a timely manner. The most common group of bacteria found in PLA is the Streptococcus Anginosus Group (SAG). Patients with PLA usually present with fever and right upper quadrant abdominal pain which can at times be referred to the right shoulder owing to dermatomal involvement. We present a case where a patient with a past medical history significant for recent diverticulosis presenting with a left lower quadrant abdominal pain, fever, and hypotension and on further workup was found to have a PLA. Blood cultures and cultures from the abscess grew Streptococcus constellatus. This bacteria is part of the SAG group however, it is rarely found in PLA and bloodstream.

A case report of multiple abscesses caused by Streptococcus intermedius

Streptococcus intermedius is a beta-hemolytic, non-motile, catalase-negative, gram-positive member of the Streptococcus anginosus group. When compared to other members of this group like S. anginosus and Streptococcus constellatus, S. intermedius infections are more substantial. In this case, we present a 47-year-old male patient who was found to have S. intermedius abscesses in his lungs, liver, and brain. The treatment of choice for these abscesses is a combination of drainage, surgery, and antibiotic therapy.

Streptococcus intermedius Bacteremia and Pyogenic Liver Abscess in a Patient With No Risk Factors

This case report depicts a 39-year-old male with no significant past medical history who was admitted for fever of unknown origin and sepsis. He was then found to have Streptococcus intermedius bacteremia and pyogenic liver abscess. The treatment course was complicated by pleural empyema leading to readmission. The case presented here adds to the medical literature, where a clear underrepresentation has been noted, and outlines a unique case of S. intermedius liver abscess complicated by pleural empyema in a patient without significant medical history, risk factors, or typical physical exam findings.

The Clinical View on Streptococcus anginosus Group – Opportunistic Pathogens Coming Out of Hiding

Three distinct streptococcal species: Streptococcus anginosus, Streptococcus intermedius, and Streptococcus constellatus, belonging to the Streptococcus anginosus group (SAG), also known as Streptococcus milleri group, have been attracting clinicians and microbiologists, not only as oral commensals but also as opportunistic pathogens. For years they have been simply classified as so called viridans streptococci, and distinct species were not associated with particular clinical manifestations. Therefore, description of SAG members are clearly underrepresented in the literature, compared to other medically relevant streptococci. However, the increasing number of reports of life-threatening infections caused by SAG indicates their emerging pathogenicity. The improved clinical data generated with the application of modern molecular diagnostic techniques allow for precise identification of individual species belonging to SAG. This review summarizes clinical reports on SAG infections and systematizes data on the occurrence of individual species at the site of infection. We also discuss the issue of proper microbiological diagnostics, which is crucial for further clinical treatment.

A rare case of massive pericardial effusion due to spontaneous rupture of Streptococcus anginosus group liver abscess

Purulent pericardial effusion is a rare and life-threatening complication of pyogenic liver abscess if not diagnosed and intervened early. Due to its nonspecific presentation, diagnosis of pyogenic liver abscess is challenging. Herein, we discuss the case of a 31-year-old healthy male that presented with acute chest tightness for one day in the setting of spontaneous rupture of pyogenic liver abscess and developed transdiaphragmatic extension of purulent pericardial effusion. The abscess resolved with antibiotic therapy (beta-lactam), ultrasound-guided aspiration, and pericardial window. Culture of pericardial fluid yielded the Streptococcus anginosus group. He was subsequently discharged following clinical resolution and normalization of liver function tests after 15 days of treatment. Follow-up ultrasonography revealed that the liver abscess and pericardial effusion were resolved in 8 weeks post treatment and intervention.