S5526 A Mystery Within: Idiopathic Intrahepatic Abscess in the Absence of Traditional Risk Factors

Introduction: Liver abscesses typically occur from hematogenous dissemination of intra-abdominal infections or from infections originating from the biliary tract. Sources of intra-abdominal infections include, but are not limited to, diverticulitis and inflammatory colitis with spread to the liver via the portal venous system. Biliary infections, such as cholecystitis and cholangitis, are also well-documented causes of liver abscesses. Less common causes include parasitic and fungal pathogens. Other risk factors for liver abscesses include diabetes, end-stage renal disease, cirrhosis, and malignancy. We present a rare case of a liver abscess with no apparent infectious source or traditional risk factors. Case Description/Methods: A 55-year-old man with a medical history of Beckwith-Wiedemann syndrome and nephrolithiasis initially presented to the hospital for evaluation of fevers, chills, and body aches. Initial workup included computed tomography (CT) of the abdomen, which demonstrated a 6.3 cm multiloculated hepatic abscess. The biliary system was unremarkable, with no evidence of cholelithiasis or biliary obstruction and a normal common bile duct diameter. The patient had undergone percutaneous drainage of the abscess with catheter placement by interventional radiology. Culture of the hepatic abscess returned with anaerobic gram-negative rods. Blood cultures remained negative throughout the hospitalization. Given the unclear etiology, a liver biopsy was recommended to rule out malignancy, and an outpatient colonoscopy was planned following completion of antibiotic therapy. Discussion: This case is notable due to the absence of a clear infectious source or predisposing risk factors. While Beckwith-Wiedemann syndrome is not currently associated with hepatic abscess formation, it may warrant further investigation in such unusual presentations. Complications of intrahepatic abscess can include pleural empyema, portal vein thrombosis, and rupture into adjacent cavities. This case demonstrates the importance of maintaining a broad differential diagnosis and considering hepatic abscesses in patients without classical risk factors.