Listeria-associated multiple granulomatous liver abscesses complicated by vena cava inferior thrombosis

Introduction Listeria monocytogenes is a gram-positive bacterium. Ingested with contaminated food this pathogen induces febrile gastroenteritis in healthy individuals and potentially fatal sepsis and meningoencephalitis in neonates, elderly and immunocompromised individuals.

Summary Herein we report a potentially clinical case concerning a 62 year old woman that was admitted to the hospital due to hyperglycemia and unintentional weight loss of 30kg within 7 months. She recalled bouts of diarrhea for 1 week quickly followed by high fever. Besides a blood glucose of 532mg/dl, her lab screen demonstrated mildly elevated cholestatic and inflammation parameters. Guided by unclear alterations in abdominal sonography, magnetic resonance imaging of the liver demonstrated multilocular complex cystoid formations within the right liver lobe, confined to segments VI to VII. Moreover, a thrombotic formation of the vena cava inferior reaching the right liver vein stuck out. Unexpectedly, blood cultures turned out positive for listeria monocytogenes. A liver needle biopsy revealed chronic, lymphoplasmacellular infiltrates with destruction and foveal fibrosis of preexistent liver parenchyma and aggregates of histiozytes like granulomas.Intravenous antibiotic therapy with Ampicillin/Sulbactam and Gentamicin was initiated and maintained for more than three weeks, respectively. Investigations for thrombophilia were negative. The thrombosis was initially treated with a low molecular weight heparin in a weight adapted dosage and then switched to an oral anticoagulation with Edoxaban. In a MRI follow up the abscess-like formations were regressive whereas the thrombosis remained stationary.

Conclusion We present an uncommon case of liver abscesses associated with Listeria monocytogenes. Consistent with other reports an untreated diabetes mellitus Typ II appeared a predisposing factor. Whether or not Listeria was causative for the thrombosis - usually seen in presence of amebic and other abscesses up to date - remains unclear.

Publication History

Article published online:
01 September 2021