Multiple pyogenic liver abscesses caused by Streptococcus constellatus in the Amazon region. Case report

There are few studies reporting pyogenic liver abscess (PLA) caused by Streptococcus constellatus in the medical literature. S. constellatus is a comensal microorganism that belongs to the Streptococcus milleri's bacteria group and is not considered to be pathogenic for humans. We report the case of a 23-year-old man with a 15-days history of abdominal pain in the right flank followed by daily fever, chills, nausea, vomits, sialism and jaundice. Physical examination revealed moderate jaundice (2+/4+), abdominal distention, generalized pain and tender over the right flank with positive Blumberg's sign. Additionally, the liver was palpable 5 cm below the costal margin in the right midclavicular line. Abdominal Computerized Tomography showed multiple hypodense hepatic images suggestive of liver abscesses. The patient underwent surgical exploration of the abdomen through a sub-costal incision and, during operation ruptured abscess localized on the hepatic segment III was drained. Culture of the purulent material obtained at surgery yielded Streptococcus constellatus as the causative agent. Liver abscess is a potential life-threatening disease that must be treated as soon as possible with invasive approaches, if necessary, and bacteriological studies performed when possible, allowing isolation of causative agents and specific antibiotic therapy.