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A3371 - Development of Pyogenic Liver Abscess from Hematogenous Spread from Dental Abscess, Presenting as Diabetic Ketoacidosis
Author Block: C. Butler1, L. Benninger2, H. Li3, D. Kay4, A. Ataya4; 1Department of Medicine, University of Florida, Gainesville, FL, United States, 2Pulmonary and Critical Care, University of Florida, Gainesville, FL, United States, 3Internal Medicine, University of Florida Shands Hospital, Gainesville, FL, United States, 4University of Florida, Gainesville, FL, United States.
Title:
Authors: Caitlin Butler MD1, Lauryn Benninger DO2, Christina Li MD1 Dana Kay DO2, Ali Ataya MD21: Department of Medicine 2: Division of Pulmonary/Critical Care
University of Florida College of Medicine, Gainesville, FL.
Introduction:
Pyogenic liver abscesses (PLA), while uncommon, are classified as either bacterial versus amebic, with bacterial being the most common. However, the development of PLA due to hematogenous bacterial transmission are rare, with only a few case reports worldwide with periodontal bacteria as origin. We are reporting a case of PLA derived from a dental abscess that presented as diabetic ketoacidosis1-4.
Case report
A 59 year-old male with medical history significant for Alcoholic Chronic Pancreatitis and Type II Diabetes Mellitus presented to our hospital for altered mental status. One week prior to hospital admission, patient had undergone root canal therapy of #19 and was prescribed Augmentin for antibiotic prophylaxis.
Upon admission, he was found to have diabetic ketoacidosis and sepsis. Patient underwent CT Abdomen/Pelvis which found a 14cm x 7.5cm perihepatic fluid collection, for which Interventional Radiology (IR) was consulted for placement of percutaneous drain. During procedure, thick purulent fluid drained from the site and cultures were obtained. Patient was started broad-spectrum antibiotics.
During hospitalization, patient’s labs normalized and on hospital day #2, patient was successfully extubated. Post-extubated, patient reported worsening vestibular swelling pain, which prompted Oral Maxillary Facial Surgery consultation. During their assessment, he was found to have loculations of purulent fluid and underwent #19 tooth extraction. Fluid analysis showed WBC of 70,000mm3, however anaerobic cultures, blood cultures, fungal cultures and cytology were all negative for organisms. Antibiotics were de-escalated to Unasyn and he was discharged with plans to follow-up with IR for drain removal.
Discussion:
We have described a case of PLA presenting as diabetic ketoacidosis, in the setting of a recent root canal therapy complicated by the development of a dental abscess. While in our case, no organisms had grown from any of the cultures. The etiology was still felt to be secondary to hematogenous spreading from the dental abscess for several reasons. First, timing of onset of symptoms, secondly, with literature
showing only approximately 35-40% of PLA culture positive, and lastly, patient had significant risk factors for hematogenous spread2,3,8,9. While rare, our case re-enforces the need for continued investigation into the etiology of both sepsis and diabetic ketoacidosis.