Hepatic abscess following NSAID use in an adolescent

Non-steroidal anti-inflammatory drugs (NSAIDs) are a known cause of peptic ulcer disease, resulting in gastrointestinal bleeding or perforation. We present a case of a sixteen year old male athlete who presented with abdominal pain and was found to have a pyogenic liver abscess secondary to a gastrohepatic fistula due to a deeply penetrating ulcer from NSAID use. This patient was successfully managed with antibiotics, a proton pump inhibitor (PPI), percutaneous drainage, and bowel rest. Perforating peptic ulcer disease (PPU) is rare in children, and this is a novel report of a resulting gastrohepatic fistula and subcapsular hepatic abscess. In otherwise healthy adolescents with abdominal complaints, a careful history of NSAID use should be obtained.