Case 325: Bacterial Infection

Diagnostic Category:

Clinical Presentation:

45 year old man with common variable immunodeficiency and recent history of night sweats and unintentional weight loss. Work-up showed elevated LFT's.

MR: Atypical bacterial infection

Imaging Findings:

MR shows centrifugal development of diffuse bacterial infection over time when compared to CT, which was acquired approximately 2 months before this MR: The larger portion of the left and right lobe are more enhancing and hyperintense on T2 compared to  the remaining periphery of the right lobe. In conjunction with the CT it is obvious that the hypovascular periphery of the right lobe is the normal portion of the liver, while the mildly enhancing parenchyma, separated by a thin line of hypovascularity (best seen on the arterial image) is the more infected part. This parenchymal alteration is not well apparent on the remainder of the contrast phases, but more obvious on DWI.

Ultrasound guided biopsy of the transition area of the zones revealed infection with filarious bacteria, likely Actinomyces bacteria.