Case history
A 67-year-old physician with a past history of hypertension, allergic
rhinitis and hepatic hemagioma for 10 years received the first dose of
ChAdOx1nCov-19 vaccine on 2021/3/22. Three days later, he presented with
fever, up to 39oC, combined with general soreness. He
took an acetaminophen tablet and his fever subsided completely. However,
fever up 39.3℃ with chills occurred on 3/31, and he was admitted for
detailed evaluation. Blood culture was done. Neither leukocytosis nor a
higher C-reactive protein (CRP) level was noted, and the Covid-19 PCR
was negative. The next day, his fever subsided and he was discharged.
However, he developed a fever, up to 38.5℃, 2 days after discharge.
Owing to persistent fever for 3 days, he subsequently visited the
infectious disease outpatient department and was admitted for further
evaluation. On admission, he had a temperature of 37.6℃, blood pressure
of 127/71 mmHg, and heart rate of 80 beats per minute. On physical
examination, he did not have a toxic appearance, but his tonsils had
erythematous enlargement. No neck lymphadenopathy was found. His chest
examination revealed clear breathing sounds, and a regular heart rhythm
without murmur. His abdominal examination revealed a soft abdomen
without rigidity or rebound, and no tenderness to palpation. There was
no lower extremity edema. His skin was intact without rashes. His white
blood cell count was 20.14×103/μL (reference range
3.8–10.8×103/μL) with 86.8% neutrophils, hemoglobin
was 12.9 g/dL (reference range 12–15.5 g/dL), and platelet count was
246×103/μL (reference range
150–450×103/μL). His liver chemistries revealed
aspartate aminotransferase of 50 U/L, alanine aminotransferase of 60
U/L, and total bilirubin of 0.64 mg/dL. Meanwhile, a CRP level of 148.56
mg/L (reference range <5
mg/L) and procalcitonin C of 3.1 ng/ml (reference range <0.5
ng/mL) were found, which revealed his inflammatory markers were
significantly more elevated than during the previous admission. His
COVID-19 nasopharyngeal swab test was still negative. Both abdominal
echography and computed tomography of the abdomen showed 4.5-cm
abscesses at left lateral segment of the liver (Figure 1). Blood
cultures were obtained and he was given empiric antibiotic treatment.
The liver abscess was drained with a pigtail catheter on the next day.
The pus smear revealed Gram-negative bacilli. Later, his blood cultures,
which had been collected during the previous admission, yieldedFusobacterium nucleatum (F. nucleatum ). He then underwent
a colonoscopy examination, which revealed diverticulosis at the cecum
and ascending colon. A dentist was consulted and asymptomatic
periodontitis was found.
The patient then received antibiotics with metronidazole and underwent
liver abscess drainage. His fever subsided completely and he was
discharged under a stable status. After 4 weeks of metronidazole
treatment, the patient was able to return to his normal daily life.