Effective treatment of listeria liver abscesses with high-dose oral antibiotics: Case insights and review of clinical challenges.

Listeria monocytogenes (L. monocytogenes) is a rare but serious pathogen, particularly in immunocompromised individuals. Hepatic listeriosis is exceptionally uncommon, making this case of multiple liver abscesses in a 55-year-old woman notable. The patient, with type 2 diabetes mellitus (T2DM), non-alcoholic fatty liver disease (NAFLD), and euglycemic diabetic ketoacidosis (eDKA) likely triggered by an SGLT2 inhibitor, presented with hypodense hepatic lesions initially suspected as metastatic disease. Mild liver enzyme elevations complicated the diagnosis, which was confirmed via blood cultures and histopathology. She responded well to a six-week course of oral amoxicillin and metronidazole, avoiding surgical intervention. This case emphasizes the need to consider infectious etiologies in immunocompromised patients with atypical imaging findings. It also highlights the role of eDKA in increasing infection susceptibility and demonstrates that conservative, non-invasive management can be effective in select cases, challenging conventional treatment approaches.