A Woman with Anorexia, Weight Loss, and Liver Lesions

In addition, the patient had cholestatic liver injury, biliary ductal dilation, and choledocholithiasis (Figure 1). An initial blood culture was negative. Although the patient had risk factors for various causes of liver lesions — prior breast cancer (predisposing to metastatic liver disease) and East Asian origin (predisposing to hydatid disease, amebiasis, and Klebsiella abscesses) — treating clinicians deemed these diseases highly unlikely. Fine-needle biopsy and mass spectrometry isolated Escherichia coli, the ultimate cause of her liver abscesses and ascending bile duct infection.