Gastrointestinal Origins of Pyogenic Liver Abscess

The misdiagnosis of the underlying cause of Klebsiella pneumoniae bacteremia1 was compounded by a failure to perform gastrointestinal investigations, such as colonoscopy and gastroduodenoscopy, to ascertain whether gastrointestinal malignancy was a source of infection culminating in pyogenic liver abscess. Notwithstanding the zero-detection rate for colorectal carcinoma in the prospective colonoscopic evaluation of 62 patients with pyogenic liver abscess (where 28 cases had adenomatous polyps, including only 1 with high-grade dysplasia),2 anecdotal reports3,4 and case series5,6 reveal a strong association between pyogenic liver abscess and colorectal carcinoma.