A 38-year-old male with a 3-year history of Crohn's disease was admitted twice due to episodes of intestinal obstruction that were treated medically without surgery.
Since her last admission, 6 months before, the patient had not been asymptomatically treated with corticosteroids and two weeks before admission, the patient consulted her primary care physician for fever and diarrhea and was thought to have had Crohn's disease exacerbation.
Persistent fever comes to the emergency department with chills, vomiting, anorexia, and right upper quadrant pain.
On examination, the patient was febrile (39 °C) with poor general condition, and abdominal distended and painful in the right hypochondrium but without hepatomegaly.
Cardiopulmonary examination was normal.
Blood count showed 26,500/mm3 deviation to the left, hemoglobin 10.6 g/l, hematocrit 3 leukocytes 490,000 and sedimentation rate 50 mm/h.
Serum chemistry revealed normal levels of transaminase and alkaline phosphatase, creatinine urea.
The chest X-ray was normal.
Abdominal CT revealed multiple abscesses in the right hepatic lobe.
No other abdominal abscesses or alterations of the gallbladder, biliary tract or pancreas were identified.
Empirical intravenous treatment was started with 80 mg gentamycin every 8 hours and 600 mg Clindamycin every 8 hours.
Before the definitive treatment of the abscess a detailed study was carried out to identify the cause of the hepatic abscess.
No alterations were observed and radiological evaluation of the small intestine revealed alterations at the level of the cyst and ileum, but there was no evidence of fistula or intestinal obstruction.
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The liver abscess was drained under ultrasound guidance, taking samples of the abscess content for culture where Streptococcus milleri grew.
Blood cultures were sterile.
Intravenous antibiotic therapy was continued for 6 weeks.
Drainage was maintained for 21 days and was removed when drainage was minimal.
His recovery was satisfactory and he was discharged after finishing the antibiotic treatment.
An abdominal CT performed 4 months later showed collapse of the abscess cavities.
