2342 Periodontal Flora Isolated From Pyogenic Liver Abscess in a Retired Dentist With Hepatic Metastasis of Colon Carcinoma

INTRODUCTION: The association of Streptococcus milleri group with pyogenic liver abscess is well recognized. Streptococcus gordonii, however, is a bacterium not of the milleri group and is included among the colonizers of the periodontal environment as it has a high affinity for molecules in the salivary pellicle on tooth surfaces. Here, we describe a case where Streptococcus gordonii was isolated from a pyogenic liver abscess in a retired dentist with hepatic metastasis of colon carcinoma. The clinical features, work up, management, and significance are described. CASE DESCRIPTION/METHODS: An 85-year-old male with colon carcinoma status post hemicolectomy complicated by metastasis to the liver status post chemotherapy and resection presented to the ED with intermittent abdominal discomfort for 2 weeks. Laboratory values were significant for WBC count of 16,000 with a predominance of granulocytes at 85%. CT of the abdomen and pelvis demonstrated a large, 7.6 cm by 5.3 cm, collection in the liver, likely an abscess. Infectious Diseases was consulted and recommended initiation of Meropenem and Daptomycin, in addition to drainage of the collection. The suspected abscess was drained by IR and Streptococcus gordonii sensitive to Linezolid was isolated on bacterial culture. The patient was transitioned to IV Linezolid and Metronidazole given susceptibilities. The patient's WBC count then began trending upwards. CT of the chest exhibited a 1.2 cm by 0.7 cm loculated pleural effusion on the right side. The pleural fluid collection was drained and a chest tube was placed. Studies of the drainage revealed an exudative process, although gram stain and culture were negative. Repeat CT imaging one week later revealed reduction in the size of the liver abscess. The WBC count normalized to less than 10,000 and the patient was discharged with a two-week course of oral Linezolid and Metronidazole with close outpatient follow-up with Infectious Diseases and Oncology. DISCUSSION: Pyogenic liver abscesses are generally associated with enteric gram-negative bacilli, Streptococcus milleri group, Streptococcus pyogenes, and Staphylococcus aureus. Hepatic abscesses secondary to periodontal flora have not been demonstrated in the literature without direct trauma to the GI tract involving foreign bodies contaminated with these organisms. We propose a possible hematogenous route of infection likely associated with possible risk factors related to the patient’s occupation as a dentist and history of dental manipulation.