salmonellosis is a well - known cause of morbidity and mortality in patients , particularly in endemic areas . it is also a well - known cause of pyogenic liver abscess [ 1 , 2 ] . it is frequently encountered in patients with pre - existing liver pathology such as amoebic abscess or echinococcus cyst . we present a case of salmonellosis complicated by pyogenic liver abscess in a previously known simple liver cyst . this signifies the importance of the fact that simple cysts can become a focus of abscess formation . a 74-year - old gentleman presented to the accident and emergency department following a 3-month stay in india . four weeks into his return , he started developing daily episodes of fever and night sweats . whilst in india , he was asymptomatic although he did not take any malaria prophylaxis or salmonella vaccine during his travel . he was also known to have a simple cyst measuring 5  cm in diameter in the right lobe of the liver , incidentally found on routine abdominal ultrasonography ( usg ) . he did not take any regular medication , and was otherwise in good health . on examination , he had a temperature of 38.2c ,   pulse 90 beats per minute regular , and blood pressure of 116/60  mmhg . his initial blood biochemical examination showed normal liver and kidney functions but a raised c - reactive protein ( crp ) of 129  mg / dl . his haematological parameters showed a raised white cell count of 12  000/cumm with predominant neutrophilia . repeated blood and urine cultures were obtained and abdominal usg requested to find any abdominal collection as a source of sepsis . the delayed start of his symptoms vis a vis his travel history made viral aetiology , namely , dengue fever unlikely . his blood culture grew salmonella paratyphi a. serologies for amoeba and hydatid disease were negative . abdominal usg showed a collection in the right liver lobe , the same site as the simple cyst noted on the previous scans . the liver abscess was drained under ultrasound guidance using a pigtail catheter and the aspirate cultures also grew salmonella paratyphi a. the patient received systemic antibiotic , ceftriaxone 2  gm intravenously once daily for 10 days based on the sensitivity report and made an uneventful recovery . on followup , he remains asymptomatic . we present a case of liver abscess caused by salmonella paratyphi a , in a previously known simple cyst of the liver . the disease severity varies from mild self - limited gastroenteritis to septicaemia and abscess formation , the later being a major cause of morbidity and mortality . salmonella infection can involve any part of the abdomen , but most commonly involves the hepatobiliary system and spleen . certain conditions such as malignancies , sickle cell disease , liver cirrhosis , and gastric achlorhydria predispose to intra - abdominal salmonella sepsis [ 79 ] .   salmonellosis is often diagnosed on blood cultures and stool cultures . pyogenic liver abscess ( pla ) is a rare presentation and most frequently caused by bacteroides , enterococcus , e. coli , klebsiella , streptococcus , staphylococcus , and salmonella spp . it is diagnosed by ultrasound guided sampling of collection followed by culture and repeated blood cultures . it is occasionally difficult to diagnose pyogenic liver disease as in up to 50% of the pla , blood cultures are negative . it is important to consider an alternative diagnosis of amoebic liver disease in a traveller returning from tropics as was our patient . absence of antibodies after one week of symptoms is almost exclusive of amoebic liver disease and stool examination for detection of cysts is recommended in case patient is a carrier for the infection . tumours of the hepatobiliary region can occasionally mimic liver abscess whilst an underlying malignancy on liver abscess is associated with poor prognosis [ 1214 ] . there has also been a case report of salmonella in polycystic liver disease . in one case report of polycystic liver disease , one of the cysts became infected with salmonella javiana that was successfully treated with percutaneous drainage and systemic antibiotic followed by installation of intracystic tetracycline as a sclerosant thus preventing a laparotomy . similarly pla caused by salmonella enteritidis has been reported in a returned traveller with hiv infection . many strategies have been proposed for treatment of pyogenic liver abscesses depending on their initial size on ct or ultrasound abdomen . some studies suggest that small abscesses ( less than 3  cm ) should be treated with intravenous antibiotics alone . large uniloculated ( more than 3  cm ) abscesses should be treated with intravenous antibiotics and percutaneous drainage in the form of ultrasound guided needle aspiration or percutaneous catheter drainage . surgical or laparoscopic drainage has been recommended for large ( more than 3  cm ) multiloculated collections . other studies suggest treatment with antibiotics alone on abscesses less than 5  cm , and percutaneous drainage or surgery for sizes more than or equal to 5  cm . our case illustrates the value of percutaneous ultrasound guided drainage either by needle aspiration or by catheter drainage to reduce the time for resolution of sepsis and prevention of mortality . it also illustrates the fact that simple liver cysts can be a focus of pyogenic liver abscess and can be treated effectively with percutaneous catheter insertion and intravenous antibiotic therapy directed by microbiological sensitivities .