Polymicrobial Pyogenic Liver Abscess Without Classical Risk Factors: A Case Report of Streptococcus constellatus and Fusobacterium nucleatum Infection.

Pyogenic liver abscesses are uncommon, often polymicrobial, and can be fatal if left untreated, with a mortality rate of 5-15%. Established risk factors include diabetes mellitus, hepatobiliary disease, malignancy, recent abdominal surgery, and immunosuppression. This case report describes a 69-year-old female who developed a large hepatic abscess despite lacking traditional predisposing risk factors. The patient is a 69-year-old female, generally healthy with only a history of osteopenia and hyperlipidemia, who presented with progressive fevers, chills, fatigue, myalgias, nasal congestion, minimally productive cough, decreased appetite, and a single episode of non-bloody, non-bilious vomiting. She had no abdominal pain but endorsed nausea and significant anorexia. Her laboratory evaluation revealed leukocytosis and elevated transaminases, coupled with a persistent fever, nausea, and anorexia, prompting a contrast-enhanced computed tomography (CT) of the abdomen and pelvis. The scan identified a hepatic abscess in the right hepatic lobe measuring 6.1 x 8.1 x 8.9 cm (volume = 439.75 cm³). The abscess was drained by interventional radiology, and cultures from the aspirate ultimately grew