A Pyogenic Liver Abscess in the Setting of Fontan-Associated Liver Disease

The Fontan procedure is widely used today in the surgical management of congenital heart disease as the final step in single ventricle palliation pathways. It is associated with unique complications, most notably Fontan-associated liver disease (FALD), which is a condition arising from the unique hemodynamics of the Fontan circulation that occurs universally after the procedure. Though varying in severity from mild hepatocellular liver injury to frank decompensated cirrhosis, FALD progresses at different rates depending on the patient. Given the significant morbidity and mortality associated with late-stage FALD, a better understanding of the pathophysiology and complications is needed. Here we describe a unique case of a pyogenic liver abscess in a patient with FALD, possibly the first reported in the literature.