An Atypical Presentation of a Pyogenic Liver Abscess Caused by Fusobacterium nucleatum Post-ruptured Appendix.

A rare formation of a pyogenic liver abscess can be found in patients with a ruptured appendix. Here, we discuss a 49-year-old male with a past medical history significant for drug-induced pancreatitis from metformin, type II diabetes, obesity, and hypertension who presented with right upper quadrant pain. He was diagnosed with a 12.6 cm pyogenic liver abscess. Upon further chart review, the patient had a laparoscopic appendectomy done nine months ago, with the findings of a ruptured appendix. The liver abscess cultures grew - a common culprit of acute appendicitis reported in several case studies and clinical trials. This case report highlights the importance of including appendectomy as an essential part of history-taking and diagnostic differential for pyogenic liver abscesses.