Pyogenic Liver Abscesses Derived From Dental Disease in an Immunocompetent Patient

Fonseca, L; Caixeirinho, P; Machado, C; Vintém Oliveira, A; Oliveira, M; Pinheiro, JM

http://hdl.handle.net/10400.17/2857

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Introduction: Pyogenic liver abscess of odontogenic origin is extremely rare. The authors report a case of pyogenic liver abscesses with oral origin caused by Prevotella denticola and Streptococcus anginosus, in an immunocompetent adult. Case Report: A 54-year-old healthy female was presented to our hospital with fever, pain in the right hypochondriac region, constipation, anorexia and history of toothache with gingival swelling. Abdominal X-ray presented showed signs of intestinal obstruction and computed tomography suggested two liver abscesses. The larger one, with 113 mm, was drained under percutaneous ultrasound guidance. Abscess culture isolated Prevotella denticola and Streptococcus anginosus. Under antibiotic therapy, the most common causes for liver abscess were excluded. Dental evaluation found multiple septic foci. Root extractions, dental restorations and periodontal treatments were performed. In this case, abscess culture result is highly suggestive of a dental origin, as species isolated are common oral pathogens. Along with the clinical findings, we are reassured about the original source of infection. Conclusion: This case illustrates the underestimated risk associated with untreated dental diseases. We believe oral infectious foci removal is imperative as primary care. Due to the increase of the cryptogenic liver abscess, we find a systematic dental evaluation is required for the etiological diagnosis of liver abscess.