case_images: PMC3843899_01
case_images: Admission CT scan showing multiple intrahepatic abscesses (arrowhead). Axial (a) and coronal (b) views are shown.
case_images: crg-0007-0482-g01.jpg
case_images: PMC3843899_01_crg-0007-0482-g01.jpg
case_images: F1
case_images: On the day of admission, repeat CT scan showed interval increase in size of his rim-enhancing liver lesions (fig. 1) as well as acute cecal diverticulitis, chronic pancreatitis and a large thrombus in the portal vein.
case_images: Microscopic examination showed fragments of neutrophil-rich debris (consistent with abscess) and liver parenchyma embedded in fibrous tissue (consistent with abscess wall). Immunohistochemical stains for tumor were negative (not shown) and no definite organisms were detected on H&E- (a) or Gram-stained sections (b) (1,000x). WS silver stain (c, d), however, revealed long rod-shaped bacteria, consistent with Fusobacterium sp. (arrowheads) (1,000x).
case_images: crg-0007-0482-g02.jpg
case_images: PMC3843899_01_crg-0007-0482-g02.jpg
case_images: F2
case_images: The liver biopsy showed neutrophil-rich debris (fig. 2a), consistent with abscess, and liver parenchyma embedded in fibrous tissue and scattered mixed inflammation consistent with abscess wall; no peliosis or viropathic changes were appreciated. No bacteria were identified on Gram stain (fig. 2b), and no fungal organisms were seen on periodic acid-Schiff diastase or Gomori methenamine-silver stains. Warthin-Starry (WS) stain, however, showed filamentous bacteria within the necrotic debris (fig. 2c, d) consistent with Fusobacterium infection.