An Unusual Case of Pyogenic Liver Abscesses Presenting with Obstructive Jaundice

Background: Pyogenic liver abscesses (PLA) are an uncommon, but potentially life-threatening infection that occur in 2.3 cases per 100,000 hospital admissions. Although the link between amebic liver abscesses and obstructive jaundice is well documented, there are few cases of PLA leading to this complication. Case Presentation: We present the case of a 48-year-old immunocompetent Hispanic male with multiple massive PLAs and obstructive jaundice on initial presentation. The results of liver-function tests were indicative of obstructive jaundice: total bilirubin 14.0 mg/dL, direct bilirubin 11.35 mg/dL, AST 388 U/L, ALT 271 U/L, alkaline phosphatase 480 µ/L. Abdominal CT and triple phase MRI revealed innumerable masses throughout the liver, with the largest measuring up to 12 cm x 16 cm. Blood cultures grew Streptococcus constellatus and liver abscess cultures grew S. intermedius – commensal organisms most often found in the GI tract. The patient was treated in the hospital for six weeks with antibiotic therapy and two percutaneous drains were placed in the largest abscesses. After clinical improvement and the resolution of the hyperbilirubinemia, the drains were removed and the patient was discharged home. Conclusion: This case illustrates a unique presentation of PLA and secondary obstructive jaundice. This complication of PLA is rare and, to our knowledge, there are only two other reported cases of a similar nature. This case highlights the importance of clinician awareness of other etiologies when evaluating patients with signs and symptoms of painful obstructive jaundice.