Liver abscess associated with persistent Streptococcus anginosus bacteremia.

A 48-year-old Samoan man presented to Tupua Tamasese Hospital in Apia, Samoa, with a 3-day history of abdominal pain and fever. Abdominal ultrasonography showed a liver abscess measuring cm. Despite surgical drainage and ther-7 ϫ 8 apy with intravenous amoxycillin and clavulanic acid, high intermittent fevers persisted. An a-hemolytic streptococcus was isolated from the surgical specimens. The patient was transferred to a private hospital in Auckland, New Zealand, for further management of his case. An additional laparotomy and surgical drainage of the abscess were performed. A moderate growth of mixed aerobic and anaerobic flora was isolated from an intraoperative pus swab sample. Intravenous therapy with benzyl penicillin and gentamicin for 2 days was followed by therapy with amoxycillin and clavulanic acid (given intravenously for 3 days and then given orally for 10 days). Three weeks later, the patient presented to Auckland City Hospital