Pyogenic Ventriculitis Secondary to Liver Abscess.

A 59-year-old man with chronic periodontitis presented with a high-grade fever. He had no medical history associated with immunosuppression. Laboratory studies showed elevated liver enzymes and inflammatory markers. Ultrasonography and magnetic resonance imaging (MRI) demonstrated liver abscess in the left hepatic lobe (Picture 1). The day after antimicrobial therapy was initiated, an altered level of consciousness appeared. Fluid-attenuated inversion recovery MRI and diffusion-weighted imaging on MRI revealed periventricular hyperintense signal and ventricular debris (Picture 2). Pyogenic ventriculitis secondary to liver abscess was diagnosed. Both lesions were drained, and Streptococcus anginosus group (SAG) was isolated from each culture. Finally, the patient was discharged with only a slight decline in his cognitive function. SAG is known for its abscess-forming tendency. We should therefore perform a whole-body scan when SAG is found (1). In addition, pyogenic ventriculitis is life-threatening, so brain MRI is recommended if an altered level of consciousness appears in a patient with liver abscess (2).

Picture 1.

Picture 2.

The authors state that they have no Conflict of Interest (COI).