Hepatic abscess presenting as severe fatigue and anemia

We describe a 54-year-old woman who had severe anemia as the initial presentation of a pyogenic hepatic abscess. She was afebrile and denied any gastrointestinal symptoms other than anorexia. We discovered her hepatic abscess when we evaluated her for an occult malignancy as the cause of her anemia. She was treated with percutaneous drainage of her abscess and parenteral antibiotic therapy. We searched MEDLINE, a computerized database, to find other patients whose hepatic abscesses presented as anemia. Although mild anemia is a common accompaniment of pyogenic hepatic abscesses, we found no reports of patients who presented with fatigue and anemia without any of the more common symptoms of hepatic abscess, such as fever, right upper quadrant pain, malaise, or nausea. We conclude that anemia without fever or abdominal symptoms is a rare presentation of pyogenic hepatic abscess.