Desulfovibrio desulfuricans bacteraemia and associated liver abscess: Case report and literature review

We present a rare case of Desulfovibrio desulfuricans bacteraemia and associated liver abscess. A 72-year-old Caucasian woman presented with an acute history of fevers, rigors and abdominal pain. She was managed empirically with ceftriaxone and metronidazole and required 24 hours of inotropic support due to hypotension from sepsis. A computed tomography scan of her abdomen demonstrated a 6cm liver abscess in maximal diameter. On day seven of her admission, blood cultures flagged an anaerobic gram-negative bacillus, which was later identified by MALDI-TOF MS as Desulfovibrio desulfuricans. The isolate was susceptible to amoxicillin-clavulanic acid, ertapenem, moxifloxacin, clindamycin and metronidazole but resistant to piperacillin-tazobactam. Despite percutaneous drainage on day two of admission, her fevers persisted for three weeks. On day nine of admission, intravenous ceftriaxone and metronidazole were switched to amoxicillin-clavulanic acid, which was administered for a total of six weeks, resulting in clinical resolution. Our case highlights Desulfovibrio desulfuricans as an uncommon cause of liver abscess and one which is important to consider if culturing an anaerobic, spiral gram-negative bacilli. Empirical antibiotics need to be carefully considered as there may be resistance to beta-lactam antibiotics including piperacillin-tazobactam.