Case: An 82-year-old female with a history of diabetes mellitus, hypertension and end stage renal disease was experiencing weakness, malaise, and anorexia. Clinical observations included: Recently diagnosed Clostridium difficile and was treated with 2 weeks course of metronidazole and probiotics containing lactobacilli. History of cholecystectomy 4 months prior to this presentation.
Cholecystectomy was complicated by bleeding in the gallbladder fossa and required laparoscopic surgery Body temperature was noted as 100.6°F (38.1°C). Abdominal examination indicated mildly tender hepatomegaly Laboratory studies revealed: Leukocytosis of 18.6k/mm3 Hemoglobin of 9.8g/dl Alkaline phosphatase of 435IU/L AST and ALT 97 and 85 IU/L respectively Purulent fluid specimen was aspirated from the liver lesion indicated Gram-positive cocci. Bacteriologic studies confirmed that they were lactobacilli…
