S2951 Case Report of Community Acquired Methicillin-Resistant Staphylococcus aureus Liver Abscess in a 38-Year-Old Immunocompetent Male With No Comorbidities
Bibliographic record
Abstract
Introduction: Pyogenic liver abscess (PLA) is a rare entity with annual incidence between 2.3 to 3.6 per 100,000 population in United States and Canada. Less than 10% of all PLA infections are caused by Staphylococcus aureus and very rarely by community acquired methicillin-resistant Staphylococcus aureus (MRSA). Herein, we present a rare case of PLA in a young immunocompetent 38-year-old man with no comorbidities, to our knowledge is only the third case of community-acquired MRSA reported in the United States. Case Description/Methods: A 38-year-old Caucasian man with past medical history of hypertension presented with 3 days of fever, jaundice, and right upper quadrant (RUQ) abdominal pain. He denied any recent travel, diarrhea, weight changes, alcohol, or intravenous drug history. He was immunocompetent and non-diabetic. He reported having leg infection treated with oral antibiotics 2 months prior to presentation. Physical examination showed presence of fever, jaundice, and RUQ tenderness. Blood tests revealed neutrophilic leukocytosis, elevated bilirubin and CRP, normal liver enzymes and alkaline phosphatase and sterile blood cultures. Imaging revealed 4.4 x 2.7 x 3.1 cm right liver lobe abscess (Figure 1) without any intra-abdominal source of infection. He was managed with Ultrasound (US) guided percutaneous drainage along with intravenous (IV) daptomycin followed by oral doxycycline for a total duration of 8 weeks based on cultures and sensitivities of aspirates. Transthoracic echocardiogram did not show any vegetations. He was found to have complete resolution of abscess with significant improvement in general condition on follow-up imaging. Discussion: PLA is an uncommon cause of hospitalization and potentially life-threatening disease caused by enteric and anaerobic species of bacteria. Risk factors like diabetes mellitus, liver transplant, malignancy, hepatobiliary or pancreatic diseases are typically present. Men are usually more affected with predominant involvement of right lobe of liver. The mode of pathogenesis is usually by direct liver injury or hematogenous spread of bacteria via portal vein and rarely through hepatic artery. Symptoms like fever, chills, RUQ pain with lab tests showing low albumin, elevated liver enzymes, bilirubin, and leukocytosis commonly present. CT with contrast or US are the imaging modality of choice, these can also be used for image guided treatment. First line therapy continues to be IV vancomycin or daptomycin with total duration of antibiotic for around 4-6 weeks.Figure 1.: CT scan shows Hypo enhancing lesion in right hepatic lobe (red arrow).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.005 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".