Complicated Isolated Liver Abscess Caused by Viridans Group Streptococci Leading to Right Hepatectomy

Pyogenic liver abscesses (PLAs) secondary to bacterial etiologies are most often seen in developing countries and are less common in North America. The predominant etiology is infection occurring in the setting of direct extension of hepatobiliary or intestinal infection. The most common pathogen isolated from a PLA in the United States is Escherichia coli, whereas Streptococcus viridans is a rare entity in the developed world. Herein we report a rare case of a complicated isolated PLA in a patient without any known comorbidities which lead to hepatectomy. The patient was born and raised in the United States with no recent travel history. The patient was found to have 10 cm isolated multicystic mass on imaging confirmed later as vancomycin-resistant Streptococcus viridans PLA. The patient was treated with multiple intravenous antibiotics and underwent multiple ultrasound-guided percutaneous abscess drainages by interventional radiology, but all unsuccessful. The patient underwent right posterior liver lobectomy, thereafter making a quick recovery and was discharged. Our case underlines the significance of considering liver abscess as a differential even in previously healthy individuals with no known prior comorbid conditions, as prompt recognition is imperative in preventing morbidity and mortality.