Actinomyces naeslundii and Eikenella corrodens as rare causes of liver abscesses

• Published in: BMJ case reports Vol. 2013; p. bcr2013009613
• Main Authors: Jaqua, Nathan Thomas, Smith, Adam J, Shin, Terry T, Jahanmir, Jay
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17.07.2013; BMJ Publishing Group
• Series: Case Report
• Subjects: Abdomen; Abscesses; Actinomyces; Actinomycosis - diagnosis; Actinomycosis - drug therapy; Anti-Bacterial Agents - therapeutic use; Catheters; Drainage; Drug Therapy, Combination; Eikenella corrodens; Family medical history; Fever; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - drug therapy; Hepatitis; Humans; Infections; Infectious diseases; Inflammatory bowel disease; Liver; Liver Abscess - diagnosis; Liver Abscess - drug therapy; Male; Middle Aged; Other; Pathogens; Rare Disease; Tomography, X-Ray Computed; USA/Canada; Viral infections
• DOI: 10.1136/bcr-2013-009613
• ISSN: 1757-790X

A 48-year-old man with an unremarkable medical history was admitted with vague conditions of fever, chills, myalgias and malaise. Physical examination was remarkable for only scleral icterus. Laboratory evaluation revealed elevated aminotransferases, alkaline phosphatase and bilirubin. Imaging demonstrated two masses in the right lobe of his liver, which were ultimately drained and cultures demonstrated Actinomyces and Eikenella. He continued to have fever on broad-spectrum antibiotics until catheter drainage of the abscesses was performed. He was eventually discharged in improved condition on amoxicillin-clavulanate. His aminotransferases, alkaline phosphatase and bilirubin continued to improve and he remained afebrile and asymptomatic. A repeat CT 2 months after discharge demonstrated resolution of the abscesses. Actinomyces and Eikenella are rare causes of liver abscesses and treatment requires drainage and an extended course of antibiotics. The polymicrobial character typical of liver abscesses makes antibiotic therapy challenging when cultures reveal rare organisms such as Actinomyces and Eikenella.