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Case report
peer-reviewed

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon



Abstract

Gram-negative urease-producing bacilli, Providencia stuartii (P. stuartii), is reported in urinary tract infections, gastroenteritis, and bacteremia in humans but they rarely present with a hepatic abscess. We present a rare case of a recurrent suprahepatic cyst due to P. stuartii in a 45-year-old female, intravenous ( IV) heroin abuser with chronic hepatitis B and C.

A 45-year-old female with 10 days status post right suprahepatic abscess drainage presented with recurrent, right, upper quadrant abdominal pain for one day. The pain was 7/10, sharp, radiated to the right back, and was associated with nausea, non-bloody non-bilious vomiting, and right-sided pleuritic chest pain. She was discharged after interventional radiology (IR) drainage of the abscess and completed 14 days of levofloxacin and metronidazole. On palpation, mild tender hepatomegaly was noticed. Complete blood count showed leukocytosis of 17.1 with left shift but liver enzymes within normal limits. Aspirated fluid cultures from the abscess showed P. stuartii. Blood and urine cultures were negative. A human immunodeficiency virus (HIV) test was negative. Hepatitis B virus (HBV) deoxyribonucleic (DNA) polymerase chain reaction (PCR) showed > 17 million IU/ml and hepatitis C virus (HCV) Ab reactive. A right, upper quadrant sonogram showed 4.1x0.9x2.7 cm fluid collection anterior to the right liver lobe. A computed tomography (CT) abdomen showed a dominant 5.2x5.5x3.9 cm hypodense lesion consistent with an abscess above the right liver. Initially, she was treated empirically with IV piperacillin-tazobactam and anticoagulation for a pyogenic liver abscess (PLA). Clinical and laboratory improvement were achieved with intravenous antibiotics evidenced by the decreasing size of the abscess on repeat CT scan. The patient was discharged with continuing antibiotics after four weeks. Repeated CT scan showed complete resolving of the suprahepatic cyst.

In conclusion, in our patient, long-term shelter residence, IV heroin use, and chronic hepatitis B and C might be precipitating factors for PLA. Managing a recurrent primary hepatic abscess caused by P. stuartii is similar to PLA from other bacterial causes: drainage and antibiotic therapy. However, in our case, she responded well to medical treatment without further surgical drainage.



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Case report
peer-reviewed

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon


Author Information

Kyawzaw Lin Corresponding Author

Medicine, The Brooklyn Hospital Center

Aung Naing Lin

Internal Medicine, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Sandar Linn

GI Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Madhavi Reddy

GI Department, 4. Gi Attending and Program Director of Gi Department, the Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Anjali Bakshi

Infectious Disease Department, 3. Id Attending and Associated Program Director of Im, the Brooklyn Hospital Center,affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon


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Case report
peer-reviewed

Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon

Kyawzaw Lin">Kyawzaw Lin , Aung Naing Lin">Aung Naing Lin, Sandar Linn">Sandar Linn, Madhavi Reddy">Madhavi Reddy, Anjali Bakshi">Anjali Bakshi

  • Author Information
    Kyawzaw Lin Corresponding Author

    Medicine, The Brooklyn Hospital Center

    Aung Naing Lin

    Internal Medicine, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

    Sandar Linn

    GI Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

    Madhavi Reddy

    GI Department, 4. Gi Attending and Program Director of Gi Department, the Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

    Anjali Bakshi

    Infectious Disease Department, 3. Id Attending and Associated Program Director of Im, the Brooklyn Hospital Center,affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 16, 2017

    DOI

    10.7759/cureus.1691

    Cite this article as:

    Lin K, Lin A, Linn S, et al. (September 16, 2017) Recurrent Primary Suprahepatic Abscess Due to Providencia Stuartii: A Rare Phenomenon. Cureus 9(9): e1691. doi:10.7759/cureus.1691

    Publication history

    Received by Cureus: August 13, 2017
    Peer review began: September 05, 2017
    Peer review concluded: September 14, 2017
    Published: September 16, 2017

    Copyright

    © Copyright 2017
    Lin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Gram-negative urease-producing bacilli, Providencia stuartii (P. stuartii), is reported in urinary tract infections, gastroenteritis, and bacteremia in humans but they rarely present with a hepatic abscess. We present a rare case of a recurrent suprahepatic cyst due to P. stuartii in a 45-year-old female, intravenous ( IV) heroin abuser with chronic hepatitis B and C.

A 45-year-old female with 10 days status post right suprahepatic abscess drainage presented with recurrent, right, upper quadrant abdominal pain for one day. The pain was 7/10, sharp, radiated to the right back, and was associated with nausea, non-bloody non-bilious vomiting, and right-sided pleuritic chest pain. She was discharged after interventional radiology (IR) drainage of the abscess and completed 14 days of levofloxacin and metronidazole. On palpation, mild tender hepatomegaly was noticed. Complete blood count showed leukocytosis of 17.1 with left shift but liver enzymes within normal limits. Aspirated fluid cultures from the abscess showed P. stuartii. Blood and urine cultures were negative. A human immunodeficiency virus (HIV) test was negative. Hepatitis B virus (HBV) deoxyribonucleic (DNA) polymerase chain reaction (PCR) showed > 17 million IU/ml and hepatitis C virus (HCV) Ab reactive. A right, upper quadrant sonogram showed 4.1x0.9x2.7 cm fluid collection anterior to the right liver lobe. A computed tomography (CT) abdomen showed a dominant 5.2x5.5x3.9 cm hypodense lesion consistent with an abscess above the right liver. Initially, she was treated empirically with IV piperacillin-tazobactam and anticoagulation for a pyogenic liver abscess (PLA). Clinical and laboratory improvement were achieved with intravenous antibiotics evidenced by the decreasing size of the abscess on repeat CT scan. The patient was discharged with continuing antibiotics after four weeks. Repeated CT scan showed complete resolving of the suprahepatic cyst.

In conclusion, in our patient, long-term shelter residence, IV heroin use, and chronic hepatitis B and C might be precipitating factors for PLA. Managing a recurrent primary hepatic abscess caused by P. stuartii is similar to PLA from other bacterial causes: drainage and antibiotic therapy. However, in our case, she responded well to medical treatment without further surgical drainage.



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Kyawzaw Lin, M.D.

Medicine, The Brooklyn Hospital Center

For correspondence:
dr.kyawzawlin2015@gmail.com

Aung Naing Lin

Internal Medicine, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Sandar Linn

GI Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Madhavi Reddy

GI Department, 4. Gi Attending and Program Director of Gi Department, the Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Anjali Bakshi

Infectious Disease Department, 3. Id Attending and Associated Program Director of Im, the Brooklyn Hospital Center,affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Kyawzaw Lin, M.D.

Medicine, The Brooklyn Hospital Center

For correspondence:
dr.kyawzawlin2015@gmail.com

Aung Naing Lin

Internal Medicine, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Sandar Linn

GI Department, The Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Madhavi Reddy

GI Department, 4. Gi Attending and Program Director of Gi Department, the Brooklyn Hospital Center, Affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201

Anjali Bakshi

Infectious Disease Department, 3. Id Attending and Associated Program Director of Im, the Brooklyn Hospital Center,affiliate of the Mount Sinai Hospital. 121, Dekalb Avenue,brooklyn, Ny 11201