Case Presentation:

A 54‐year‐old African American woman with a history of asthma presented with a 3‐week history of left lower quadrant (LLQ) pain associated with subjective fever, nausea, and vomiting. Her medical history was unremarkable except for diverticulosis diagnosed in 2008 by routine colonoscopy. The patient denied any illicit drug use or alcohol abuse. There was no history of recent travel. She was not sexually active. Vital signs were significant for a temperature of 100.8°F, blood pressure 168/90 mm Hg, heart rate 93/min, respiratory rate 18/min, and SpO2 100% on ambient air. On physical examination, her heart sounds were regular, and lungs were clear to auscultation. The abdomen was soft, but there was tenderness over the LLQ without rebound tenderness or guarding. Labs revealed leukocytosis and elevated liver enzymes. Serologic investigation for hepatitis B and C, HIV, and Entamoeba histolytica antigen were all negative. Abdominal CT revealed multiple hypodense lesions in the liver. The patient underwent percutaneous drainage, and culture of the purulent and foul‐smelling material yielded Streptococcus constellatus. She was successfully treated with continuous drainage and prolonged use of broad‐spectrum antibiotics.


S. anginosus, S. intermedius, and S. constellatus form the S. milleri group. These organisms colonize the intestinal tract and are not considered pathogenic except when any invasive manipulation is performed. Interestingly, this group of microorganisms is characterized by a tendency to form abscesses in different organs. When isolated, it should prompt a search for simultaneous infections at other locations. Although there are many reports confirming liver abscesses secondary to S. milleri species, only few cases have been reported, indicating S. constellatus as the cause of such infections. S. constellatus abscess is clinically distinct from other forms of pyogenic liver abscess because of its torpid nature, which necessitates prolonged use of antibiotics. Therefore, it is important to recognize S. constellatus as a pathogen of liver abscess in order to give optimal doses and duration of antibiotics.


Liver abscess is a potential life‐threatening disease. Bacteriological studies should be performed to isolate causative agents and give specific antibiotic therapy. Even though it is rare, Streptococcus constellatus is an important pathogen of liver abscess because of its unique characteristics.


T. Shinha ‐ none; P. Nautiyal ‐ none; K. Perumareddi ‐ none