University of Wisconsin–Madison Medical College of Wisconsin

Clostridioides difficile Pyogenic Liver Abscess With an Empyema

Suhas P. Dasari, BS; Mit A. Patel, BS; Vishmayaa Saravanan, BS; Sanjana Jha; Kayla L. O’Sullivan BS; Harpreet S. Gill, BS; Pramod Acharya, MD; Pinky Jha, MD

WMJ. 2022;121(1):e5-e9

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Introduction: Reports of extraintestinal manifestations of Clostridioides difficile (C difficile) infections are rare. The frequency of these infections comprises approximately 0.17% to 0.6% of all C difficile infections. While they are becoming more frequent worldwide, the precise trend is unclear.

Case Presentation: An 83-year-old female patient presented with pleuritic chest pain 2 to 3 months after a needle biopsy of her liver abscess confirmed C difficile. She was found to have extension of the liver abscess into the chest cavity, leading to empyema, and was treated with intravenous antimicrobials.

Discussion: This is the fifth known reported case of C difficile leading to a pyogenic liver abscess and the first case where the C difficile liver abscess was associated with an empyema. While long-term metronidazole is considered effective for managing extra intestinal C difficile infection, our patient was treated with vancomycin and meropenem.

Conclusion: To determine epidemiology and a proper treatment regimen for extraintestinal C difficile infection, a greater accumulation of cases is necessary.

Author Affiliations: Department of Internal Medicine, Medical College of Wisconsin (MCW), Milwaukee, Wis (Dasari, Patel, Saravanan, Jha S, O’Sullivan, Gill, Jha P); Department of Infectious Disease, MCW, Milwaukee, Wis (Acharya).
Corresponding Author: Suhas P. Dasari, email; ORCID ID 0000-0001-7161-7305.
Funding/Support: None declared.
Financial Disclosures: None disclosed.
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