B73-31 Hypervirulent Klebsiella Pneumoniae in a Healthy Adult: A Rare but Recognized Pattern of Severe Infection

Abstract Hypervirulent Klebsiella pneumoniae (hvKp) is an emerging pathogen distinct from classical Klebsiella pneumoniae, known for its enhanced virulence and ability to cause severe, invasive infections in otherwise healthy individuals. Unlike traditional strains, hvKp is associated with pyogenic liver abscesses, bacteremia, pneumonia, and metastatic complications such as endophthalmitis and meningitis. It often exhibits a hypermucoviscous phenotype and carries virulence-associated genes, making it a formidable clinical challenge. Here we present a case of community acquired hvKP infection in an immunocompetent adult. 58-year-old male with Asthma presented to PCP with complaints of acute onset painful vision loss in the left eye associated with photophobia and floaters. Bilateral temporal artery biopsies were obtained, and the patient was started on empiric prednisone treatment. Surgical pathology was non-diagnostic of temporal arteritis, and the prednisone was discontinued. Septic work up including blood cultures and urine cultures were sent and was started on broad-spectrum intravenous antibiotics. Intra vitreous antibiotic was started due to concern for endophthalmitis.CT Chest revealed multiple cavitary lung nodules, the largest measuring 18 mm in size. CT Abdomen pelvis was consistent with 34mm indeterminate hepatic lesion, left pyelonephritis, cystitis and questionable prostatitis. CMV and EBV serologies, Fungal culture, Fungitell, Toxoplasma IgM, and syphilis were negative. Quantiferon was indeterminate. Blood cultures were consistent with pan-sensitive Klebsiella pneumoniae species. The culture from the eye also grew Klebsiella. IR-guided biopsy of the hepatic lesion was consistent with a Klebsiella abscess. Despite the intravenous and intravitreal antibiotics, the endophthalmitis worsened and the patient underwent enucleation of the left eye. Hypervirulent Klebsiella pneumoniae (hvKP) strains are known to cause invasive infections associated with high in-hospital mortality. Risk factors for hvKP include liver abscesses, diabetes mellitus, and immunocompromised status. In our case, the patient presented with symptoms of endophthalmitis progressed to bacteremia with metastatic spread as septic pulmonary emboli, pyelonephritis, liver abscess, cystitis, and prostatitis. We postulate that liver abscess was the primary source for this patient. While hvKP originated in the Southeast Asian subcontinent, these strains are often antibiotic-resistant compared to European and North American strains which acquire resistance in nosocomial settings. Prior case reports have noted components of immunosuppression such as recent cancer diagnosis, steroid use, and autoimmune conditions. Our patient immunocompetent and the hvKP was community-acquired. Community-acquired hvKP infections are frequently seen in immunocompromised patients within the US. Early identification of hvKP and antibiotic-resistant species is the key to reducing mortality and morbidity in the affected patients. This abstract is funded by: SELF