An Atypical Presentation of a Pyogenic Liver Abscess Caused by Fusobacterium nucleatum Post-ruptured Appendix

Area of Science:

• Hepatology
• Infectious Diseases
• Surgical Case Reports

Background:

• Pyogenic liver abscesses are uncommon complications of intra-abdominal infections.
• Ruptured appendix is a rare but documented cause of pyogenic liver abscess.
• Fusobacterium nucleatum is a known pathogen associated with appendicitis.

Observation:

• A 49-year-old male with diabetes, obesity, and hypertension presented with right upper quadrant pain.
• Imaging revealed a large (12.6 cm) pyogenic liver abscess.
• Patient's history included a laparoscopic appendectomy nine months prior for a ruptured appendix.

Findings:

• Liver abscess cultures identified *Fusobacterium nucleatum*.
• *F. nucleatum* is a common bacterium found in acute appendicitis.
• This case links a prior ruptured appendix to a subsequent liver abscess.

Implications:

• Highlights the importance of a detailed patient history, including prior surgeries.
• Suggests considering appendectomy history in the differential diagnosis of pyogenic liver abscesses.
• Underscores the potential for intra-abdominal infections to manifest as distant abscesses.