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Keywords :
Cardiovascular disorders, Dentistry, Gastroenterology and hepatology, Infectious diseases, Obstetrics and gynecology
Key Clinical Message :
Fusobacterium spp. should be on the differential for any organ abscess, especially when there are multiple sites of infection, including but not limited to, the liver, brain, or lungs. When patients have concomitant periodontal disease, Fusobacterium spp. should be higher on the differential since they are typically oral flora.
Summary:
Fusobacterium nucleatum is an anaerobic Gram-negative rod commonly found in the oral cavity. We report a woman recently living in a Puerto Rican cult, presenting with abdominal pain and weight loss, found to have a liver abscess growing F. nucleatum extending to the pericardium, as well as a tubo-ovarian abscess.
Background :
Fusobacterium species are anaerobic Gram-negative rods that are considered normal flora in the human oral cavity but are also rarely seen as opportunistic infections in oral and extraoral diseases such as the case presented below (1). Despite their ubiquitous presence in the general population, most clinicians are not familiar with this organism as a pathogen due to its typically innocuous nature. F. nucleatum has rarely been associated with a number of conditions including periodontitis (2), peri-implant disease (3), chorioamnionitis (4), pre-term births (5-7), pericarditis (8), and organ abscesses- typically in the brain, liver, or lungs (6, 9, 10). Fusobacteria are not commonly encountered in clinical practice; in one retrospective analysis Fusobacterium spp. bacteremia is seen in 5.5 out of one million cases of bacteremia per year (11). We present a case of disseminatedF. nucleatum resulting in a pyogenic liver abscess with pericardial involvement as well as a tubo-ovarian abscess.
Case Presentation:
A previously healthy woman in her 20s presented with three weeks of fatigue, abdominal pain and unintentional weight loss. She had recently returned from living in the Puerto Rican jungle with a known cult that emphasized living off the land with unusual beliefs that precluded regular body hygiene.  On examination, she was febrile to 103.9o F, tachycardic to 130 bpm with no murmurs, rubs, or gallops, but otherwise hemodynamically stable and with an unremarkable physical exam outside of poor hygiene.