Pyogenic liver abscess due to Bacillus cereus: Case report

Abstract

Introduction: Pyogenic liver abscess is a rare and serious infection with a high mortality rate. Bacillus cereus, although known for food poisoning, rarely causes liver lesions. Its diagnosis is based on imaging and culture. In Cuba, underreporting limits epidemiological knowledge and hinders effective prevention and control strategies.

Objective: To describe an unusual case of pyogenic liver abscess due to Bacillus cereus.

Case presentation: In March 2025, a 78-year-old patient with a history of type 2 diabetes and a prolonged febrile syndrome of unknown origin was diagnosed at the Pedro Kourí Institute of Tropical Medicine. She was admitted with a fever of 39°C, chills, progressive abdominal pain in the upper abdomen, vomiting, and fatigue. Physical examination revealed dry mucous membranes, tachycardia, and focal abdominal pain. Leukocytosis was detected, and a chest X-ray revealed an elevated right hemidiaphragm and pleural effusion. Ultrasound revealed a 4x4cm liver lesion. Empirical treatment with piperazine-tazobactam and metronidazole was initiated. After percutaneous drainage, the patient cultured Bacillus cereus. The patient was switched to clindamycin, with favorable outcome and discharge after 21 days.

Conclusions: This case is unusual due to the rarity of the detection of this bacterium as the causative agent of the condition. Percutaneous drainage and culture of the resulting sample are reaffirmed as the diagnostic method of choice for achieving favorable outcome and recovery in patients with pyogenic liver abscess.