BMJ Case Reports 2017; doi:10.1136/bcr-2016-218423
  • Findings that shed new light on the possible pathogenesis of a disease or an adverse effect

Lactobacillus: the not so friendly bacteria

  1. Juliet Uwagwu2
  1. 1Department of General Surgery, Lewisham and Greenwich NHS Trust, London, UK
  2. 2Department of Microbiology, Lewisham and Greenwich NHS Trust, London, UK
  1. Correspondence to Dr Abirami Pararajasingam, apararajasingam{at}
  • Accepted 20 June 2017
  • Published 13 September 2017


We present a 65-year-old diabetic patient with a complex liver abscess and bacteraemia from Lactobacillus paracasei. The abscess resulted in a prolonged hospital stay due to ongoing sepsis despite ultrasound-guided drainage and broad-spectrum antibiotics. Furthermore, the patient developed several secondary complications including a right-sided pleural effusion, an inferior vena cava thrombus and septic lung emboli. The abscess was eventually managed successfully with a prolonged course of antibiotics and multiple ultrasound-guided drainage procedures.

To our knowledge, this is the first reported case of probiotic consumption, confirmed by strain identification, as the likely source of a liver abscess. Probiotic products have been widely used for many years and are advocated to the general public for their health benefits with no warning of side effects. Lactobacilli are one group of bacteria commonly used in these products. Although rare, complications have been reported. Susceptible patients, such as those who are immunocompromised, should be advised against excessive consumption.


  • Contributors AP: completion of case report and approval of final version to be published. JU and the Microbiology department at Queen Elizabeth Hospital: contribution to case report and approval of final version to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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