Acute Presentation of Simultaneous Liver Abscesses Caused by Streptococcus constellatus

Simultaneous liver abscesses are rarely seen and reported. We are reporting a case of two simultaneous, complex liver abscesses in a patient who had no evidence of liver abscess on cross-sectional imaging close to three months prior to this presentation. These abscesses were 7-8 cm in size, large, and septated. Microbiological studies were positive for Streptococcus constellatus, which is a known cause of pyogenic liver abscess. In our patient, pyogenic liver abscesses were associated with bacteremia and sepsis. This patient was managed with broad spectrum parenteral antibiotics and percutaneous drainage with improvement in clinical condition. This patient was discharged home with a peripherally inserted central catheter (PICC) line in place to complete a six-week course of parenteral antibiotics. A complete history and physical with pertinent examination findings are key to diagnosis of liver abscess. S. constellatus should be considered in the differential diagnosis of patients with liver abscess and sepsis.