Quang Anh suffered from back pain and difficulty walking, along with occasional fevers of unknown origin. He had previously been diagnosed with a lumbar disc herniation and received medical treatment, but his symptoms persisted. Recently, with recurrent fever and severe back pain, he sought examination at a musculoskeletal clinic.

Blood test results at Tam Anh Cau Giay General Clinic indicated elevated inflammation and infection markers. However, upon reviewing his medical records and treatment history, doctors noted that the recurrent pain and fever were inconsistent with a spinal condition.

An abdominal ultrasound revealed a suspected abscess in the right liver lobe. MRI results confirmed a large liver abscess in the right lobe, measuring approximately 51x59x79 mm. This abscess featured a multi-septated structure with interconnected pus-filled compartments, thick walls, and signs of inflammation in the surrounding liver parenchyma. Doctors also identified a smaller lesion in segment 4 of the left liver lobe, measuring about 14x12 mm, containing several small fluid pockets.

MRI scan showing a large liver abscess in the patient. *Photo: Tam Anh General Hospital*

Master of Science, Doctor Ngo Thuy Dung, from the Department of Gastroenterology - Hepatobiliary - Pancreatology at Tam Anh General Hospital Hanoi, stated that the liver abscess had clearly progressed with two lesions. The larger one in the right liver lobe had developed multiple interconnected pus-filled septa. Quang Anh was prescribed antibiotic treatment combined with drainage to clean the infection site, aiming to prevent and control complications.

Doctors performed a percutaneous drainage of the right liver abscess under ultrasound guidance, aspirating stagnant pus, relieving pressure, and reducing bacterial load. Approximately 100 ml of greenish pus was drained, sent for culture, and antibiotic susceptibility testing. The results identified the causative agent as *Streptococcus intermedius*, a strain of streptococcus known for its propensity to cause pus formation and deep abscesses in the body.

Doctor Dung explained that *Streptococcus intermedius* is a bacterium commonly found in the oral cavity and digestive tract without causing illness. However, under certain favorable conditions, such as inflammation, mucosal injury, or after invasive procedures, this bacterium can breach natural protective barriers, enter the bloodstream, and travel to other organs, leading to infections.

Following a period of treatment, the infection improved, the drained fluid volume decreased, and back pain subsided. Upon discharge, the patient was free of fever, abdominal pain, and back pain, showing good recovery.

Quang Anh made a good recovery after a period of intensive treatment. *Photo: Tam Anh General Hospital*

According to Doctor Dung, Quang Anh's back pain symptoms were related to his previously diagnosed spinal condition. However, the deep liver infection exacerbated the pain. Liver abscesses often develop silently, presenting with nonspecific symptoms like abdominal pain and back pain, which are easily mistaken for other common ailments.

Patients experiencing prolonged or recurrent fever of unknown origin, accompanied by chills, shivering, and fatigue, should seek medical examination for screening and diagnosis. Doctors may recommend ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) depending on the specific case. Everyone should practice proper oral hygiene, promptly treat any oral infections, and undergo regular health check-ups to detect abnormalities early.

Ly Nguyen