SEPTIC SHOCK SECONDARY TO FUSOBACTERIUM NECROPHORUM LIVER ABSCESSES AND QUESTIONABLE RELATIONSHIP WITH COVID-19 INFECTION IN A HEALTHY YOUNG FEMALE

ABSTRACT

SESSION TITLE COVID-19 Case Report Posters 2 SESSION TYPE Case Report Posters PRESENTED ON 10/19/2022 1245 pm - 0145 pm INTRODUCTION: Fusobacterium (FB) are anaerobic, Gram-negative bacilli found in the normal flora of the oral, gastrointestinal, vaginal and upper respiratory tract mucosa. It can cause soft tissue infections and rarely causes bacteremia, yet Fusobacterium bacteremia is associated with high rate of ICU admission, extended hospitalization and significant mortality. Pyogenic liver abscess is a rare indolent disease and is mostly secondary to bacterial infection. CASE PRESENTATION A 39-year-old female with no comorbidities presented with nausea, vomiting, fatigue, diarrhea, fatigue, heavy menstrual bleed, and high-grade fever. Symptoms started four days before the presentation. She reported a positive COVID-test two weeks earlier and a new IUD placement five weeks before presentation. She is sexually active with one male partner and does not use a contact barrier. On presentation, she was hypotensive, tachycardic, ill-looking with rapid shallow breathing, and fever of 100.7. EKG showed sinus tachycardia, CXR showed no pulmonary disease. Blood tests were significant for leukocytosis, elevated serum lactic acid, and elevated D-dimer. CTA chest was remarkable for two 2x3 cm liver cysts. Patient was admitted to the MICU and started on IV fluids Boluses, Norepinephrine drip, Ceftriaxone and Azithromycin. Gynecology was consulted and recommended against removing the IUD as patient had no signs of IUD infection. Patient continued to be critically sick. Gynecology team was recontacted and removed the IUD and was uninfected on culture. Antibiotics were switched to Vancomycin and Piperacillin-Tazobactam. MRI liver with contrast confirmed the diagnosis liver abscess. Patient received bedside US-guided aspiration, it was remarkable for 16 cc of frank pus. Patient showed significant improvement after procedure and was transferred to the medical floor within 24 hours. Blood culture grew F. Necrophorum and antibiotics were switched to Clindamycin. DISCUSSION: FB is part of the vaginal flora. Mucosal disruption during IUD placement can precipitate disseminated infection with liver abscesses and/or sepsis. Absence of signs of GU tract infection or a non-infective IUD doesn't rule out FB sepsis. Patient Presented five weeks after IUD placement which fits the indolent nature of pyogenic liver abscess. Four cases of F. Nucleatum bacteremia were reported recently in Belgium in COVID patients. One of the cases was healthy young female. Our similar scenario raises a question about a potential association between COVID and risk of floral septicemia. Our patient has F. necrophorum. CONCLUSIONS: Patient presenting with sepsis and liver cyst should be evaluated for liver abscess as appropriate. Recent procedures and mucosal instrumentation can precipitate liver abscess and should be considered if the timing suggest an indolent course. Further studies are needed to evaluate a potential link between COVID infection and FB bacteremia. Reference #1 Goldberg EA, Venkat-Ramani T, Hewit M, Bonilla HF. Epidemiology and clinical outcomes of patients with Fusobacterium bacteraemia. Epidemiol Infect. 2013 Feb;141(2)325-9. doi 10.1017/S0950268812000660. Epub 2012 Apr 17. PMID 22717143. Reference #2 Garcia-Carretero R. Bacteraemia and multiple liver abscesses due to Fusobacterium nucleatum in a patient with oropharyngeal malignancy. BMJ Case Rep. 2019 Jan 29;12(1)e228237. doi 10.1136/bcr-2018-228237. PMID 30700472;PMCID PMC6352811. Reference #3 Wolff L, Martiny D, Deyi VYM, Maillart E, Clevenbergh P, Dauby N. COVID-19-Associated Fusobacterium nucleatum Bacteremia, Belgium. Emerg Infect Dis. 2021 Mar;27(3)975-977. doi 10.3201/eid2703.202284. Epub 2020 Dec 8. PMID 33292922;PMCID PMC7920680. DISCLOSURES No relevant relationships by Zainab Abdulsada No relevant relationships by Ahmed Abomhya No relevant relationships by Richard Fremont