Streptococcus viridans Liver Abscess and Septicemia Likely Secondary to a Swallowed Dental Bridge

Pyogenic liver abscesses are relatively rare in developed countries such as the United States, and, when they do occur, they are typically secondary to direct or hematogenous spread of intra-abdominal pathologies. Gastrointestinal pathogens such as Escherichia coli and Enterococcus species are typically implicated. Conversely, the Streptococcus viridans group is a rare cause of bacteremia and abscess formation, especially in immunocompetent patients. We present a case of a 53-year-old male who presented with S. viridans liver abscess that was found to be secondary to a swallowed dental bridge that was lodged in the patient's descending colon. The patient was treated with intravenous antibiotics, percutaneous drainage, and colonoscopy for removal of the foreign body; the patient had a good response to treatment and was discharged on oral antibiotics. In any patient who has fever and abnormal liver function tests, hepatobiliary sepsis including liver abscess should always be excluded. Additionally, it is important to suspect unusual pathogens and sources of infection. We suggest empiric broad-spectrum antibiotic coverage when liver abscess is suspected and tailoring treatment as the specific organism and susceptibilities are identified. Moreover, we suggest the importance of removing any foreign bodies promptly upon discovery as they may serve as an important nidus of infection.