A rare case report of pyogenic hepatic abscess secondary to sigmoid diverticulitis

Hepatic abscesses are uncommon and rarely associated with diverticulitis as an indirect source of infection. We report the case of a 60-year-old male with a history of recurrent diverticulitis who presented with fever, nausea, and abdominal pain demonstrating a single multiloculated hepatic lesion measuring 5.8 × 5.1 × 5.1 cm upon admission. Piperacillin–tazobactam was initiated for sepsis management, and metronidazole was initiated for amoebic coverage. Aspiration and drainage of the abscess were performed, and cultures confirmed Streptococcus intermedius, prompting antibiotic therapy to be narrowed to ceftriaxone and metronidazole. Subsequent imaging showed a reduction in the size of the abscess. A pyogenic liver abscess can rarely arise from hematogenous spread of infection via the portal venous system in the setting of diverticulitis. Early imaging, prompt antimicrobial therapy, and source control are essential to optimize outcomes and prevent complications.