Liver Abscess in a Returning Traveller: A Case Report

Background: This case describes a liver abscess diagnosed in a returning traveller with three different microorganisms potentially implicated as the causative agent. The varied potential causative agents (including both bacteria and parasites) made the management of this case uniquely challenging, adding to the existing literature on liver abscesses. Case: A 70-year-old gentleman, who is a returning traveller from Thailand, presented with confusion and mouth ulcers. He had mildly deranged liver function tests on admission and a CT scan of the abdomen revealed liver abscesses. This was initially treated with antibiotics, and subsequently by insertion of percutaneous hepatic drains, however the gentleman developed septic shock after insertion of the percutaneous drains. Microbiology results revealed a positive Shistosoma serology, a Prevotella denticola bacteraemia and Streptococcus intermedius was cultured from the fluid drained from the abscesses. The gentleman was eventually treated with Praziquantel and the size of the abscesses and his liver function tests gradually improved. Conclusions: Given the reported polymicrobial nature of liver abscesses described in existing literature, there may be some doubt as to the correct antimicrobial treatment used to treat liver abscesses, especially if greater than one potential causative microorganisms are isolated. The case also highlights a complication associated with treatment, being septic shock secondary to drainage of liver abscesses. Few guidelines exist on the management of liver abscesses, and the difficulties faced in our investigation and treatment of this gentleman with liver abscesses emphasise the need for formal guidelines on the investigation and treatment of liver abscesses.