Rare case of bacteremia, liver abscess and possible infective endocarditis caused by Fusobacterium nucleatum.
Despoina Spentzouri, Petros Ioannou, Andria Papazachariou et al.
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Case in brief
A 75-year-old man with type 2 diabetes presented with high fever, rigors, and hemodynamic instability; examination revealed a new systolic murmur. Investigations showed inflammation, elevated liver enzymes, and two left-lobe liver abscesses on imaging. Blood cultures grew Fusobacterium nucleatum, and transesophageal echocardiography showed aortic-valve vegetation; he met Modified Duke criteria for infective endocarditis. A history of dental procedures one month earlier was elicited. He recovered after six weeks of targeted ceftriaxone and metronidazole therapy.
What made this case unusual
F. nucleatum was associated with both liver abscesses and aortic-valve infective endocarditis in this patient, following recent dental procedures.
Diagnostic / clinical pearl
In unexplained sepsis with a deep-seated abscess or recent dental procedures, consider anaerobic bacteremia and assess for endocarditis with echocardiography and anaerobic blood cultures.