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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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PYOGENIC LIVER ABSCESSES DERIVED FROM DENTAL DISEASE IN AN IMMUNOCOMPETENT PATIENT

Luis Sanches Fonseca1 , Patrícia de Deus Caixeirinho1 , Maria do Céu Machado1 , Ana Vintém Oliveira2 , Marvin Oliveira3 , Jorge Manuel Pinheiro4

1 Resident in Stomatology, Department of Stomatology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal;
2 Consultant in Internal Medicine, Intensive Care Unit, Centro Hospitalar de Lisboa Central, Lisbon, Portugal;
3 Resident in Clinical Pathology, Department of Clinical Pathology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal;
4 Consultant in Stomatology, Department of Stomatology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal

- J Case Rep Images Dent 2018;4:1–5

Introduction: Pyogenic liver abscess of odontogenic origin is extremely rare. The authors report a case of pyogenic liver abscesses with oral origin caused by Prevotella denticola and Streptococcus anginosus, in an immunocompetent adult. Case Report: A 54-year-old healthy female was presented to our hospital with fever, pain in the right hypochondriac region, constipation, anorexia and history of toothache with gingival swelling. Abdominal X-ray presented showed signs of intestinal obstruction and computed tomography suggested two liver abscesses. The larger one, with 113 mm, was drained under percutaneous ultrasound guidance. Abscess culture isolated Prevotella denticola and Streptococcus anginosus. Under antibiotic therapy, the most common causes for liver abscess were excluded. Dental evaluation found multiple septic foci. Root extractions, dental restorations and periodontal treatments were performed. In this case, abscess culture result is highly suggestive of a dental origin, as species isolated are common oral pathogens. Along with the clinical findings, we are reassured about the original source of infection. Conclusion: This case illustrates the underestimated risk associated with untreated dental diseases. We believe oral infectious foci removal is imperative as primary care. Due to the increase of the cryptogenic liver abscess, we find a systematic dental evaluation is required for the etiological diagnosis of liver abscess.

Palavras Chave: Dental focal infections, Liver abscess, Prevotella denticola, Streptococcus anginosus;