When hiccups mean something more than just a nuisance: A rare presentation of pyogenic liver abscess

Pyogenic liver abscess (PLA) is an uncommon yet potentially fatal disease. The disease most commonly arises from biliary infection but may also result from hematogenous seeding and portal spread secondary to bowel contamination, direct seeding, or penetrating trauma. The diagnosis is suspected when there is a hepatic lesion on imaging. Confirmation of diagnosis requires purulent aspirate or bacterial growth on Gram stain/culture of the abscess or blood. The mainstay of treatment is antimicrobials in conjunction with either percutaneous abscess drainage or aspiration. Surgical drainage is reserved for cases of ruptured abscess, peritonitis, or in the presence of an underlying surgical cause. PLA typically presents with fever and abdominal symptoms. We report a case of an unusual manifestation of PLA, presenting as hiccups, which led to a significant delay in the diagnosis and treatment.