Pneumococcal perihepatitis due to hematogeneous dissemination

Area of Science:

• Infectious Diseases
• Hepatology
• Microbiology

Background:

• Perihepatitis is commonly associated with pelvic inflammatory disease (PID), typically caused by Neisseria gonorrhoeae or Chlamydia trachomatis.
• PID-related perihepatitis is usually seen in sexually active individuals with relevant symptoms or findings.

Observation:

• A 61-year-old female presented with fever and right upper quadrant pain, diagnosed with perihepatitis via contrast-enhanced computed tomography.
• The patient had no history of sexual activity or symptoms suggestive of PID.
• Blood cultures identified Streptococcus pneumoniae, suggesting a hematogenous dissemination route.

Findings:

• The case demonstrates that Streptococcus pneumoniae, a common cause of invasive pneumococcal disease, can lead to perihepatitis.
• This challenges the typical understanding of perihepatitis etiology, which is predominantly sexually transmitted infections.

Implications:

• Blood cultures are crucial for determining the causative pathogen and infection route in perihepatitis, especially in patients without risk factors for PID.
• This finding broadens the differential diagnosis for perihepatitis, emphasizing the need to consider non-gynecological sources like pneumococcal bacteremia.