“Self-Referred” – A Physician’s experience of referred ear pain as a symptom of pyogenic liver abscess, a case report

Abstract

Background: The presenting symptoms of liver abscess are typically non-specific, including pyrexia, right upper quadrant tenderness, nausea/vomiting and fatigue. We discuss a case of pyogenic liver abscess which presented with non-specific symptoms and severe left-sided ear pain. To our knowledge, this is a previously unreported presenting symptom of liver abscess in adulthood. This case is also somewhat unique in that the primary author is the patient in question. Case Report: A young male patient in his twenties, working as a junior doctor, presented with a seven-day history of intermittent pyrexia, fatigue, nausea, vomiting and severe left-sided ear pain. A CT abdomen/pelvis revealed a large liver abscess in the right hepatic lobe. A percutaneous drain was inserted with US guidance and the patient completed a prolonged course of antibiotics (14 weeks total) with CT-confirmed resolution of the abscess at that point. The left-sided ear pain resolved within hours of the percutaneous drain insertion. Conclusions: To our knowledge, this is the first reported case of a liver abscess in an adult patient presenting with severe left-sided ear pain. We propose that this pain was secondary otalgia due to vagus nerve irritation at the level of the liver abscess.

Keywords

• Pyogenic liver abscess
• Secondary otalgia
• Vagus nerve