S25 Aseptic Hepatic Abscess Formation Via Inoculation From Crohn's Disease in a Patient on Adalimumab

Case: Hepatic abscesses are a rare extraintestinal manifestation of in ﬂ ammatory bowel disease (IBD) with only 60 cases reported in the literature, the majority of which being in Crohn ’ s disease (CD) patients. In ulcerativecolitis(UC) patients, Streptococcus isthe mostcommonpathogen identi ﬁ edin hepatic abscesses followed by Escherichia coli, and Staphylococcus aureus is the most common cultured hepatic abscess aspirate from Crohn ’ s disease patients. In extremely rare cases, however, no pathogen is isolated, and these so-called visceral aseptic hepatic abscesses represent part of the spectrum of neutrophilic disease and an extremely rare manifestation of IBD. Our case illustrates a middle-aged female with Crohn ’ s disease on adalimumab presenting with an aseptic hepatic abscess. A 49-year-old female with a history of longstanding Crohn ’ s disease on adalimumab status-post partial ileal resection, atrial ﬁ brillation on apixaban, chronic obstructive pulmonary disease, lupus, and hypothyroidism presented for 2 days of cramping right hemi-abdominal pain, fever, and vomiting. Her vitals were within normal limits. Labs showed a mild leukocytosis of 11.1 with neutrophilic predominance, an erythrocyte sedimentation rate of 67, and a C-reactive protein of 20.64. The rest of her labs were unremarkable. Computed tomography (CT) of the abdomen/pelvis showed