P1915 - Pyogenic Hepatic Abscess Caused by Cronobacter Sakazakii – A Case Report and Review of Literature

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Mahum Nadeem, MD

University of Oklahoma Health Sciences Center
Oklahoma City, OK, United States

Mahum Nadeem, MD¹, Yusra M. Nasir, MBBS², Adnan Malik, MD³, Maryam Haider, MD⁴, Khawaja H. Akhtar, MD⁵, Hashroop Gurm, MD¹
¹University of Oklahoma Health Sciences Center, Oklahoma City, OK; ²King Edward Medical University, Lahore, Punjab, Pakistan; ³Loyola University Medical Center, Maywood, IL; ⁴Wayne State University, Detroit Medical Center, Detroit, MI; ⁵Oklahoma University Health Sciences Center, Oklahoma City, OK

Introduction: Cronobacter sakazakii is a rod-shaped gram-negative bacterium previously known as Enterobacter sakazakii. It is commonly found in dry foods including infant formulas, skimmed milk, herbal teas and dried starches. It rarely causes infection in neonates with only 4-6 cases being reported to the CDC every year. The infection in adults is even rarer and most commonly occurs in immunocompromised states. Thus, we present a rare case of pyogenic hepatic abscess in an elderly male caused by Cronobacter sakazakii.

Case Description/Methods: A 64-year-old male with history of back pain (received multiple steroid injections) who presented to the ER with right upper quadrant abdominal pain with fever and night sweats. Initial labs were significant for leukocytosis and transaminitis. Liver ultrasound revealed hepatic abscess and intrahepatic perforation of gallbladder, which was confirmed on abdominal CT scan (Figure A). Patient underwent IR guided drainage of hepatic abscess and placement of cholecystostomy tube. This was followed by an open cholecystectomy. The cultures from the abscess showed heavy growth of Cronobacter sakazakii. Patient was initially started on Piperacillin/Tazobactam which was switched to Ciprofloxacin following susceptibility testing (Figure B). He showed marked improvement and was discharged with outpatient follow up.

Discussion: Cronobacter sakazakii is an emerging food borne pathogen causing life threatening severe neonatal meningitis and necrotizing enterocolitis in premature infants fed with contaminated infant formula. Risk factors predisposing our patient include: history of receiving multiple epidural steroid injections for debilitating lumbar back pain[1], frequent use of herbal teas to boost concentration[2]. Per our literature review the association with herbal tea has been reported once before[2]. Only 3 cases have been reported in adults involving the GI tract. Currently antibiotic therapy with drainage of abscess is the treatment of choice for Cronobacter infections. Our case hypothesizes immunocompromised state and herbal teas as possible risk factors for this rare infection.
References:
1. Stout A, Friedly J, Standaert CJ. Systemic Absorption and Side Effects of Locally Injected Glucocorticoids. Pm r 2019;11:409-419.
2. Al-Nabulsi AA, Osaili TM, Shaker RR, et al. Survival of Cronobacter Species in Reconstituted Herbal Infant Teas and their Sensitivity to Bovine Lactoferrin. Journal of Food Science 2009;74:M479-M484.

Figure: CT Scan of abdomen showing Liver abscess ( arrow) along with antibiotic susceptibilities

Author	Year	Age	Sex	Presentation	Infection	Comorbidities	Recovery
Lai et al.	2001	73	Female	Painless jaundice	Biliary Abscess	Klatskin tumor	Died from biliary sepsis on day 4
See et al.	2007	75	Female	Diffuse abdominal pain	Splenic and parasplenic abscesses	None	Recovered in 2 weeks
Sahra et al	2021	81	Male	Diffuse abdominal pain	Cholangitis	BCC, Liver Cirrhosis, TIPS	Recovered

Table: Table 1: Literature Review of Pyogenic Hepatic Abscess caused by Cronobacter sakazakii

Disclosures:

Mahum Nadeem indicated no relevant financial relationships.

Yusra Nasir indicated no relevant financial relationships.

Adnan Malik indicated no relevant financial relationships.

Maryam Haider indicated no relevant financial relationships.

Khawaja Akhtar indicated no relevant financial relationships.

Hashroop Gurm indicated no relevant financial relationships.

Mahum Nadeem, MD¹, Yusra M. Nasir, MBBS², Adnan Malik, MD³, Maryam Haider, MD⁴, Khawaja H. Akhtar, MD⁵, Hashroop Gurm, MD¹. P1915 - Pyogenic Hepatic Abscess Caused by Cronobacter Sakazakii – A Case Report and Review of Literature, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.