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Updated: Dec 12, 2025
Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
Published on: December 4, 2023
Complicated Isolated Liver Abscess Caused by Viridans Group Streptococci Leading to Right Hepatectomy
Muhammad F Ahmed1, Zainab Abbasi2, Sajan Das3
1Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA.
Abstract:
Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are most often seen in developing countries and are less common in North America. The predominant etiology is infection occurring in the setting of direct extension of hepatobiliary or intestinal infection. The most common pathogen isolated from a PLA in the United States is Escherichia coli, whereas Streptococcus viridans is a rare entity in the developed world. Herein we report a rare case of a complicated isolated PLA in a patient without any known comorbidities which lead to hepatectomy. The patient was born and raised in the United States with no recent travel history. The patient was found to have 10 cm isolated multicystic mass on imaging confirmed later as vancomycin-resistant Streptococcus viridans PLA. The patient was treated with multiple intravenous antibiotics and underwent multiple ultrasound-guided percutaneous abscess drainages by interventional radiology, but all unsuccessful. The patient underwent right posterior liver lobectomy, thereafter making a quick recovery and was discharged. Our case underlines the significance of considering liver abscess as a differential even in previously healthy individuals with no known prior comorbid conditions, as prompt recognition is imperative in preventing morbidity and mortality.
Insights
This case report details a rare instance of a complicated pyogenic liver abscess (PLA) caused by vancomycin-resistant Streptococcus viridans in a healthy US patient. Despite extensive treatment, surgical resection was ultimately required, highlighting the need for broad differential diagnoses.
Area of Science:
- Hepatology
- Infectious Diseases
- Surgical Pathology
Background:
- Pyogenic liver abscesses (PLAs) are uncommon in North America, typically arising from direct extension of intra-abdominal infections.
- Escherichia coli is the most frequent pathogen; Streptococcus viridans is a rare cause in developed nations.
Observation:
- A US-born patient without comorbidities presented with a large, isolated, multicystic liver mass.
- Imaging confirmed a 10 cm lesion, later identified as a vancomycin-resistant Streptococcus viridans pyogenic liver abscess.
Findings:
- Standard treatments including intravenous antibiotics and percutaneous drainage were unsuccessful.
- The patient required a right posterior hepatectomy for definitive treatment of the complicated PLA.
Implications:
- This case underscores the importance of considering PLAs in healthy individuals, even with unusual pathogens.
- Prompt diagnosis and consideration of surgical intervention are crucial for managing complex liver abscesses to prevent severe morbidity and mortality.
