Gastrointestinal Variant of Lemierre Syndrome due to <i>Fusobacterium nucleatum</i>: A Case Report

Abstract

<b><i>Introduction:</i></b> Pyogenic liver abscess is a noteworthy health concern in North America, characterized by a mortality rate ranging from 2 to 12%. This condition is often polymicrobial, with <i>Streptococcus</i> species and <i>Escherichia coli</i> as the predominant causal pathogens in Western countries. <i>Fusobacterium</i> species, typically commensals of gastrointestinal, genital, and oral flora, have been implicated in the rare formation of tonsillar abscesses and Lemierre syndrome, including its gastrointestinal variant known as pylephlebitis. <b><i>Case Presentation:</i></b> We present the case of an immunocompetent male with a 2-week history of abdominal distention and pain. Abdominal magnetic resonance imaging revealed multiseptated cystic hepatic masses and portal vein thrombosis. A subsequent liver biopsy confirmed <i>Fusobacterium nucleatum</i> etiology. The patient was initiated on intravenous cefepime and oral metronidazole antibiotics. Unfortunately, the patient succumbed to cardiac arrest before a final diagnosis could be established. <b><i>Conclusion:</i></b> <i>Fusobacterium</i> species-associated liver abscess, coupled with the rare gastrointestinal variant of Lemierre syndrome (pylephlebitis), poses a significant mortality risk. This case underscores the rarity and clinical challenges associated with these conditions. Increased awareness among clinicians is crucial for early diagnosis and prompt intervention, potentially improving outcomes in such cases.