Liver abscesses as an initial manifestation of Crohn’s disease

A 33-year-old man with no relevant medical history who presented with fever, right hypochondrium pain and diarrhoea for the previous five days. Blood tests showed hypertransaminasaemia, elevated acute phase reactants, anaemia and coagulopathy. Abdominal computed tomography revealed hepatomegaly, three liver lesions suggestive of abscesses, the largest 13 cm in size, and thickening of the distal ileum (Figs. 1 and 2). Empirical intravenous antibiotic therapy was started and percutaneous drainage of the abscesses was performed, isolating Streptococcus viridans. A colonoscopy only showed stenosis of the ileocaecal valve. An abdominal MRI showed a thickening of 15 cm of the distal ileum. Biopsies of the valve confirmed Crohn’s disease (CD). After controlling the infection, infliximab was started for CD, currently in remission. Tests for liver disease, including magnetic resonance cholangiopancreatography, were without findings.

Fig. 1.

Cross-sectional abdominal computed tomography with intravenous contrast showing a space-occupying lesion in the liver compatible with liver abscess.

Fig. 2.

Cross-sectional abdominal computed tomography with intravenous contrast showing thickening of the distal ileum.

Liver abscesses are a rare complication in CD.^1–3 They tend to occur in young people with long-standing or severe active disease and are rarely the initial manifestation.^1,3 They can be caused by vascular seeding, local extension, fistulas allowing the infection to spread from abdominal organs, or ascending biliary infection.^1,3 Common symptoms are fever, chills, anorexia, weight loss, vomiting and abdominal pain, similar to a flare-up.^1,3 The treatment of choice is antibiotic therapy and drainage, depending on the abscess size.^1–3