Treatment of liver abscess caused by Klebsiella pneumoniae with multi-site infection: a case report

Pyogenic liver abscesses are a fatal condition often seen in emergency departments. The major clinical presentations include weakness, anorexia, fever, chills, ventosity and abdominal pain. They occur in immunocompromised individuals who suffer from diabetes mellitus, malignant tumors, hepatocirrhosis, kidney failure, and solid organ transplantation, or those with long-term administration of glucocorticoids. Invasive Klebsiella pneumoniae liver abscess syndrome resulting from hypervirulent Klebsiella pneumoniae often presents with extrahepatic complications such as endophthalmitis, meningitis, brain enlargement, pneumonia, necrotizing fasciitis, and spondylitis. Prompt diagnosis is crucial for the treatment of invasive Klebsiella pneumoniae liver abscess syndrome. A 75-year-old Han Chinese female patient who presented to the emergency department primarily for fever accompanied by chills was diagnosed with pyogenic liver abscess complicated with pulmonary infection, involving multiple pus emboli in the branches of the right hepatic vein. The patient accepted intravenous imipenem and cilastatin sodium for anti-infection, and subcutaneous insulin to control hyperglycemia. Percutaneous liver puncture and drainage was performed under ultrasound guidance. During the treatment the patient presented with headache, weakness in both lower limbs and lower back pain. Brain magnetic resonance imaging showed intracranial infection and lumbar magnetic resonance imaging showed infection of the vertebral body, intervertebral disc, and soft tissue. The patient had a liver abscess positive for Klebsiella pneumoniae together with infection of other organs, thus she was eventually diagnosed with invasive Klebsiella pneumoniae liver abscess syndrome. The antibiotics were adjusted according to the site of infection and drug sensitivity test. The patient recovered after percutaneous liver puncture and drainage under ultrasound guidance and anti-infection treatment for 3 months. Reexamination of abdominal computed tomography, chest computed tomography, brain magnetic resonance imaging and lumbar magnetic resonance imaging suggested that the infectious lesions had disappeared. This medical case report describes a patient with a pyogenic liver abscess caused by Klebsiella pneumoniae who was eventually diagnosed with invasive Klebsiella pneumoniae liver abscess syndrome. Invasive Klebsiella pneumoniae liver abscess syndrome has permanent morbidity, poor quality of life, and lacks warning signs. Despite the complexity of the condition, the patient received effective treatment and the abscess was successfully managed. Through this case, we propose that invasive Klebsiella pneumoniae liver abscess syndrome caused by hypervirulent Klebsiella pneumoniae should be considered for patients with diabetes and fever in the emergency department. Targeted intravenous antibiotics and percutaneous drainage of the abscess are key to the treatment of invasive Klebsiella pneumoniae liver abscess syndrome.