Cynthia Sandanamsamy^1,, Lai Nai Kiat Sean¹, Chan Weng Kit¹, Naganathan¹, Ganesh Kasinathan²

Background: Culture negative abscesses at multiple sites are a common phenomenon. It is an important source of sepsis and septic shock in many developed and developing countries worldwide. Case Presentation: This case describes a 42 year-old Malay gentleman who presented to us with high grade fever associated with cough, foul-smelling sputum and pleurisy. He has underlying chronic Type 2 Diabetes Mellitus. He works as a rubber tapper, a smoker with a 40 pack years history, and a teetotaler. On physical examination, he had notable pyrexia with stable vital signs. He was septic looking and had obvious rigors. His dental hygiene was poor with multiple caries. Lungs were clear on auscultation. Examination of the abdomen revealed tender hepatosplenomegaly. Chest radiograph showed multiple cavitating lesions suggestive of lung abscesses. A subsequent Contrast Enhanced Computed Tomography (CECT) of the thorax, abdomen and pelvis revealed multiple lung, liver, splenic and adrenal abscesses of different sizes. A 2D transthoracic echocardiogram did not reveal any vegetation. Tuberculosis and viral screening were negative. His melioidosis serology titer was not significant. Multiple sets of blood, sputum and urine cultures did not grow any organism. He was treated for culture negative abscesses with a six week course of parenteral third generation cephalosporin antibiotics and metronidazole. Repeated imaging showed significant improvement of all abscesses and he responded well clinically. Conclusion: Effective and early management of culture negative abscesses with broad spectrum antibiotics is vital in reducing overall mortality and morbidity.

pyrexia, hepatosplenomegaly, tuberculosis, adrenal, metronidazole