FUSOBACTERIUM NUCLEATUM: A RARE CAUSE OF CRYPTOGENIC ABDOMINAL AND HEPATIC ABSCESSES IN AN IMMUNOCOMPETENT TEENAGER Jared Robinson, Carl Giffin; LSUHSC School of Medicine, New Orleans, LA.
Introduction: Fusobacterium nucleatum is a gram-negative, anaerobic opportunist in the gastrointestinal mucosa. Rarely, it is associated with infections causing pyogenic liver abscesses, which typically occur in immunocompromised patients. In this novel case, it presents in a young, immunocompetent patient as cryptogenic, monomicrobial, and multifocal abscesses. Case: A 19-year-old male without a significant past medical history presented with three weeks of fevers, right shoulder pain, and weight loss with an 8.5×4×7cm subcapsular and 6×4×2.5cm right hepatic lobe abscess after not improving on Augmentin for a pneumonia diagnosis two weeks prior. He denied recent dental procedures, but frequently enjoys water sports and often accidentally aspirates lake water. On exam, he had decreased right lower lung breath sounds, right shoulder pain without palpation tenderness or movement restriction, and no abdominal tenderness or distension. UDS was positive for opiates and THC. He was HIV negative with leukocytosis, elevated ALP, AST, and ALT. Imaging also revealed colonic diverticulosis and an appendicolith without a visualized appendix. He was empirically treated with Vancomycin, Zosyn, and CT- guided percutaneous abscess drainage. Initial abscess cultures grew Fusobacterium nucleatum while
blood cultures remained negative. No skin lesions were identified as a source and oral examination was normal. Imaging from his initial presentation revealed a hepatic lesion that may have caused the appearance of a pulmonary process secondary to atelectatic changes. Diverticular workup was normal. Given the cultures and abdominal imaging findings, his condition was presumably due to a preceding subacute appendicitis with rupture and abscess formation. His symptoms and pulmonary processes attenuated rapidly following therapy. Bacterial coverage was narrowed to Zosyn following Fusobacterium growth. When interval imaging showed significantly attenuated abscesses, he was discharged with a month of Augmentin, two weeks of fluconazole, and follow-up with Infectious Disease. Discussion: This case had an unclear etiology and, due to previous antibiotic therapy, an obfuscated picture of potential pathogens. While rare in young patients lacking immunological risk factors, this case illustrates the pathogenicity of F. nucleatum to form persistent, ravenous monomicrobial pyogenic liver abscesses with an initially indolent presentation. With hastened identification and aggressive treatment, patients will have the best chance for a good outcome.
GENITOURINARY AND SEXUAL HEALTH CARE FOR WOMEN WITH CANCER: OVERLOOKED QUALITY OF LIFE INDICATORS Hannah Dellacroce, Nancy Ren, Andrew Chapple, Sydni Barras, Shawna Morron, Tara Castellano, Navya Nair, Amelia Jernigan; LSUHSC School of Medicine, New Orleans, LA.
Introduction: The purpose of this study was to characterize the prevalence of oncologist- reported counseling for genitourinary syndromes (GUS) or sexual health concerns (SHC) in women with cancer being cared for at an urban academic safety net hospital. Methods/Results: A retrospective study of 514 women receiving cancer treatment or follow-up care was performed. Demographics and clinical data were abstracted from patient charts to investigate factors associated with screening for GUS or SHC. Charts were further reviewed to determine whether the
oncologist initiated a treatment or referral process for patients endorsing GUS or SHC. Statistical analyses were conducted using R statistical software version 4.0.2. A total of 68 of 514 (13.2%) subjects were asked about GUS or SHC by their oncologist. Of patients that had these discussions, 25 (36.8%) endorsed GUS or SHC. The majority (96.0%) of patients who reported GUS or SHC received treatment or referral for further care. Roughly one-third of gynecologic cancer survivors (37.2% of cervical cancer, 31.3% of ovarian cancer, 36.8% of vulvar cancer, and 30.2% of uterine cancer) discussed GUS or SHC with their oncologist. In contrast, only 7.2% of breast, 5.1% of 55
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