C0573 - Case Report of Community Acquired Methicillin-Resistant Staphylococcus aureus Liver Abscess in a 38-Year-Old Immunocompetent Male With No Comorbidities

Dhruvanshu Patel, MD¹, Arouj Bajwa, MD², Mihir Ankola, MBBS³, Kimberly Chaput, MD⁴, Jeffrey Jahre, MD^4
1St. Luke University Health Network, Easton, PA; ²St. Luke's University health Network, Bethlehem, PA; ³BJ Medical College, Easton, PA; ⁴St. Luke University Health Network, Bethleham, PA

Introduction: Pyogenic liver abscess (PLA) is a rare entity with annual incidence between 2.3 to 3.6 per 100,000 population in United States and Canada. Less than 10% of all PLA infections are caused by Staphylococcus aureus and very rarely by community acquired methicillin-resistant Staphylococcus aureus (MRSA). Herein, we present a rare case of PLA in a young immunocompetent 38-year-old man with no comorbidities, to our knowledge is only the third case of community-acquired MRSA reported in the United States.

Case Description/Methods: A 38-year-old Caucasian man with past medical history of hypertension presented with 3 days of fever, jaundice, and right upper quadrant (RUQ) abdominal pain. He denied any recent travel, diarrhea, weight changes, alcohol, or intravenous drug history. He was immunocompetent and non-diabetic. He reported having leg infection treated with oral antibiotics 2 months prior to presentation. Physical examination showed presence of fever, jaundice, and RUQ tenderness. Blood tests revealed neutrophilic leukocytosis, elevated bilirubin and CRP, normal liver enzymes and alkaline phosphatase and sterile blood cultures. Imaging revealed 4.4 x 2.7 x 3.1 cm right liver lobe abscess (Figure 1) without any intra-abdominal source of infection. He was managed with Ultrasound (US) guided percutaneous drainage along with intravenous (IV) daptomycin followed by oral doxycycline for a total duration of 8 weeks based on cultures and sensitivities of aspirates. Transthoracic echocardiogram did not show any vegetations. He was found to have complete resolution of abscess with significant improvement in general condition on follow-up imaging.

Discussion: PLA is an uncommon cause of hospitalization and potentially life-threatening disease caused by enteric and anaerobic species of bacteria. Risk factors like diabetes mellitus, liver transplant, malignancy, hepatobiliary or pancreatic diseases are typically present. Men are usually more affected with predominant involvement of right lobe of liver. The mode of pathogenesis is usually by direct liver injury or hematogenous spread of bacteria via portal vein and rarely through hepatic artery. Symptoms like fever, chills, RUQ pain with lab tests showing low albumin, elevated liver enzymes, bilirubin, and leukocytosis commonly present. CT with contrast or US are the imaging modality of choice, these can also be used for image guided treatment. First line therapy continues to be IV vancomycin or daptomycin with total duration of antibiotic for around 4-6 weeks.



Disclosures:


Dhruvanshu Patel, MD¹, Arouj Bajwa, MD², Mihir Ankola, MBBS³, Kimberly Chaput, MD⁴, Jeffrey Jahre, MD⁴. C0573 - Case Report of Community Acquired Methicillin-Resistant Staphylococcus aureus Liver Abscess in a 38-Year-Old Immunocompetent Male With No Comorbidities, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.