A 38-year-old man with a history of Crohn's disease of 3 years' evolution and admitted on two occasions for episodes of intestinal obstruction that were treated medically without the need for surgery. Since his last admission, 6 months earlier, the patient had remained asymptomatic and two weeks before admission, the patient consulted his GP for fever and diarrhoea and was thought to be suffering from an exacerbation of Crohn's disease, receiving treatment with corticosteroids without objective improvement. Given the persistence of fever, he attended the emergency department with chills, vomiting, anorexia and pain in the right hypochondrium.
On examination, the patient was febrile (39°C) with poor general condition, and a distended and painful abdomen in the right hypochondrium but without hepatomegaly. Cardiopulmonary examination was normal. The haemogram showed leukocytosis of 26,500/mm3 with a left shift, haemoglobin 10.6 g/l, haematocrit 36.3%, platelets 490,000 and sedimentation rate of 50 mm/h. Serum biochemistry showed normal levels of transaminases and alkaline phosphatase, creatinine and urea. Chest X-ray was normal. Abdominal CT revealed multiple abscesses in the right hepatic lobe. No other abdominal abscesses or abnormalities of the gallbladder, bile duct or pancreas were identified. Empirical intravenous treatment with Gentamicin 80 mg every 8 hours and Clindamycin 600 mg every 8 hours was started. Before definitive treatment of the abscess, a detailed study was performed to identify the cause of the liver abscess. On colonoscopy, no abnormalities were observed and radiological evaluation of the small bowel revealed several strictures at the level of the jejunum and ileum but no evidence of fistulae or intestinal obstruction.

The liver abscess was drained under ultrasound control, and samples of the abscess contents were taken for culture where Streptococcus milleri grew. Blood cultures were sterile. Intravenous antibiotherapy was continued for 6 weeks. Drainage was maintained for 21 days and removed when drainage was minimal. His recovery was satisfactory, and he was discharged after completion of antibiotic treatment. An abdominal CT scan performed 4 months later showed collapse of the abscess cavities.