Misidentified Metastases: Diagnosing and Managing Pyogenic Liver Abscesses in a Breast Cancer Survivor

BACKGROUND Pyogenic liver abscesses are collections of pus of varying sizes within the liver. They are rare and often overlooked in developed countries, and if left untreated, they can be life-threatening. Therefore, early detection and treatment are crucial for favorable outcomes. Due to the atypical presentation, a high level of suspicion is necessary, as seen in our patient's case. CASE REPORT This report pertains to a 76-year-old woman who was diagnosed with sepsis resulting from multiple hepatic abscesses. Initially, the abscesses were mistaken for metastatic breast cancer liver disease due to her history of breast cancer in remission for 3 years. However, further imaging and biopsy revealed the initial diagnosis to be incorrect. She had initially presented with nonspecific abdominal pain and diarrhea. The initial computed tomography (CT) scan of the abdomen indicated the development of extensive hepatic lesions, thought to be associated with breast cancer, but subsequent magnetic resonance imaging (MRI) suggested liver abscesses. Ultrasound-guided aspiration confirmed the presence of liver abscesses, and subsequent culture of the aspirate revealed the growth of Streptococcus intermedius. The patient responded well to a 4-week course of antibiotic therapy. CONCLUSIONS This case report reviews the clinical presentation, risk factors, diagnosis, and management of multiple pyogenic liver abscesses, and shows the importance of using sound clinical reasoning in addressing diagnostic challenges of this nature.