22 yo M with fever and RUQ pain

Original case by Brandon Fainstad, MD. 
Edits, updates and graphics by Yilin Zhang, MD.


OBJECTIVES:


CASE:

22 year old previously healthy man with two days of fever, night sweats and RUQ pain.  He has had an unintentional 10lb wt loss in the past 6wks and a self resolving flu-like illness 6 mos ago.  He denies nausea/vomiting, diarrhea, cough, SOB, dysuria, skin or hair changes.  He has no past medical history and does not take medications.  He grew up in China, moved to the US 6 years ago.  He last traveled to China and Japan two years ago and denies any additional international travel.  He denies any tobacco, EtOH or injection drug use.

On exam he is febrile to 38.6C, HR 110 bpm, BP 125/70 and SpO2 96%. His abdomen is soft, tender in the RUQ without a Murphy’s sign or rebound tenderness. Labs are significant for WBC 14k, Tbili 2.1. CBC and BMP are otherwise normal.

His CT imaging showed the following:

What are the possible etiologies for this liver lesion in an otherwise healthy 22 year old man?

How would you further evaluate him?


FINAL DIAGNOSIS:

How is it treated? 


TAKE HOME POINTS:


REFERENCES:

  1. Davis, J & McDonald, M. Pyogenic liver abscesses. Bloom, A (ed.) in UpToDate, Inc. Maltham, MA. Accessed on November 19, 2017.
  2. Yu, WL & Chuang, YC. Invasive liver abscess syndrome caused by Klebsiella pneumoniae. Bloom, Allyson (ed.) in UpToDate, Inc. Maltham, MA. Accessed on November 19, 2017.

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