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Liver abscess due to parvimonas micra
Cynthia Ramírez Castro1, Mikel Fiallegas Cano2, Pelayo Rodríguez López3
1Aparato Digestivo, Hospital Universitario de Galdakao-Usansolo, España.
Abstract:
Liver abscesses are an entity that sets out a diagnostic challenge with a severe clinical course and non-negligible mortality. Their origin is usually bacterial (>80%), parasitic, mixed or, more rarely, fungal. We present the case report of a 45-year-old man, native of Ghana, with no relevant medical-surgical history, was admitted for septic shock with multiple organ dysfuntion syndrome. Complementary imaging tests revealed a liver abscess in segments IV and VII measuring 60x45x54 mm, so antibiotic treatment with piperacillin-tazobactam was started and a pigtail drainage was placed. In blood cultures, the microorganism parvimonas micra (anaerobic gram-positive cocci) was isolated with high degree of sensitivity rates to penicillin, clindamycin and metronidazole. Treatment was de-escalated to clindamycin until completing 4 weeks of intravenous treatment. Control CT showed a decrease in the size of the abscess and pigtail drainage was removed.
Insights
A rare liver abscess caused by Parvimonas micra, an anaerobic bacterium, presented a diagnostic challenge. Prompt antibiotic treatment and drainage led to successful patient recovery, highlighting effective management strategies for this uncommon infection.
Area of Science:
- Infectious Diseases
- Hepatology
- Microbiology
Background:
- Liver abscesses present significant diagnostic and management challenges due to their potential for severe clinical courses and mortality.
- Bacterial infections are the most common cause of liver abscesses, accounting for over 80% of cases.
Observation:
- A 45-year-old man presented with septic shock and multiple organ dysfunction syndrome, revealing a large liver abscess.
- Imaging confirmed a liver abscess in segments IV and VII, measuring 60x45x54 mm.
Findings:
- Blood cultures identified Parvimonas micra, an anaerobic gram-positive coccus, as the causative agent.
- The isolated microorganism demonstrated high sensitivity to penicillin, clindamycin, and metronidazole.
- Initial treatment with piperacillin-tazobactam followed by de-escalation to clindamycin, alongside pigtail drainage, resulted in abscess reduction.
Implications:
- This case underscores the importance of considering rare pathogens like Parvimonas micra in liver abscess diagnosis.
- Effective management involves timely diagnosis, appropriate antibiotic therapy, and source control through drainage.
- Successful treatment of Parvimonas micra liver abscesses is achievable with targeted antimicrobial strategies.
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