WHAT APPEARS TO BE CANCER

We describe a case of multiple hepatic pyogenic abscesses with an unus ual presentation. The typical signs and symptoms of fever and pain in the right upper quadrant were absent. Instead, the chief complaint was muscle weakness and myalgias accompanied by weight loss. Findings fro m an ultrasonogram of the abdomen revealed multiple hepatic lesions co nsistent with metastases. Hence, the initial presumptive diagnosis was metastatic malignancy with unknown primary tumor. It was only when pu rulent material was unexpectedly encountered when a needle biopsy was performed that the true diagnosis of pyogenic liver abscess was recogn ized. While liver abscess is rare, it should not be forgotten in the d ifferential diagnosis for multiple hepatic lesions seen on imaging stu dies.