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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.